Sternal Research Articles

Syndrome Sinistre: Left Brachiocephalic Vein Compression and its Neurological Manifestations.

Embryologically, the left brachiocephalic vein (LBV) originates as an anastomotic channel between the right and left anterior cardinal veins. This positions the LBV between the manubrium sterni anteriorly and the innominate artery posteriorly. This pattern of adjacency of the aorta to the LBV is unique to mammals and results from a quirk of evolution. With age, the ascending aorta unfolds, elongates and dilates. Simultaneously, there is a change in the thoracic geometry that reduces the thoracic volume primarily from disc height loss and kyphosis. These transitions progressively compress the LBV. Normally, this compression is circumvented via collateral pathways and "Blood finds a way". However, traversing these circuitous pathways comes at a cost and can result in delayed transit times and venous congestion. While it is possible that compression of the LBV in the setting of adequate collateral channels may fail to provoke any pathologic sequelae, we propose a phenomenon in which such compression in the setting of inadequate collateral circulation may lead to a state of pathologic venous congestion. This anatomic anomaly and its associated clinical features, if identified, can offer a new avenue for treatment options for some of the hitherto unexplained neurologic disorders.

505. USE OF INDOCYANINE GREEN FOR ASSESSMENT OF GASTROPLASTY VASCULARIZATION AFTER MCKEOWN ESOPHAGECTOMY

Abstract Background Anastomotic leakage is one of the most feared complications of esophagogastric surgery, conferring significant morbidity and mortality in these patients. It is known that inadequate vascularization of the gastroplasty is a major risk factor for anastomotic dehiscence. The aim of this study is to evaluate and demonstrate the utility of intraoperative use of indocyanine green (ICG) in patients undergoing esophagectomy and reconstruction with gastroplasty to assess the relationship between its vascularization and the presence of anastomotic leakage in the postoperative period. Methods Prospective, longitudinal, observational, and analytical study of 36 consecutive cases in which intraoperative ICG was used for patients undergoing McKeown esophagectomy and reconstruction with gastroplasty and cervical anastomosis from June 2021 to December 2023. The distance traveled by the ICG in a proximal direction from the pylorus at 30 and 90 seconds after its intravenous infusion was measured. An automatic baseline point or point of maximum fluorescence was also recorded and compared both in net value and in percentage at 30, 60, 90, and 120 seconds after the infusion of ICG with the theoretical zone of anastomosis construction (zone reaching the sternal manubrium after extending the graft over the sternum). Statistical analysis was performed using SPSS version 24.0. Results The rate of leaks and necrosis of the graft was 19.4% and 2.8%, respectively. There is a significant relationship (p<0.05) between the rate of anastomotic dehiscence and the net value and percentage compared with the automatic baseline point of ICG at the anastomosis site and at the apex of the gastroplasty at 30, 60, 90, and 120 seconds. Using a ROC curve (figure 1) that analyzed the time it takes for ICG to reach the anastomosis, a cutoff point of 19.5 seconds was established, which gives ICG greater profitability as a diagnostic test with an AUC of 0.821 (0.642-1). The positive predictive value of this test is 0.36, and the negative predictive value is 1. Conclusion The use of indocyanine green appears to be a good method for identifying those anastomoses and gastroplasties that present a high risk of dehiscence and/or necrosis. The time it takes for ICG to reach the anastomosis, the speed at which it does so, as well as the quantitative value provided by the platform used, seem to be valid parameters for identifying high-risk cases. This would allow for the performance of additional measures to reduce the risk of dehiscence and/or necrosis. Randomized prospective studies with a larger sample size would be necessary.

Assessing the impact of corrosive acids on human bone integrity in forensic context.

Dissolving bodies is a contemporary method of disposing of human remains and has been practiced throughout the years. This research article discussed the impact of readily available corrosive chemicals, such as Hydrochloric acid (HCl), Sulfuric acid (H2SO4), and Expelz™ toilet cleaner, on human bone. Unfortunately, the existing literature on this subject is scarce, with only a few studies conducted on human bones. To address this gap, we conducted an experimental analysis using human sternum bone fragments. These samples were subjected to immersion in different acids, namely HCl and H2SO4, at two concentrations (10% and 37%), and Expelz™ toilet cleaner. This research aims to describe the impact of toilet cleaner, sulphuric acid, and hydrochloric acid on bone tissue deterioration at various time intervals. Further, the morphological alterations weight loss, and cytological analysis of bone tissue residue with various acid concentrations and immersion times (3.5, 9, 24, 36, 48, 60, and 72h) were analyzed. Among the chemicals examined, it is evident that 37% hydrochloric acid (HCl) and sulfuric acid (H2SO4), regardless of refreshment, exhibit the highest reactivity, resulting in the complete decomposition of hard tissue within a few hours. In contrast, the behaviour of 10% H2SO4 reveals a more intricate degradation process characterized by fluctuations in weight loss. These distinct reactivity profiles under different conditions are crucial in understanding the potential for rapid weight loss, signifying high reactivity and more gradual weight loss, indicating a faster decomposition rate. Notably, refreshment of the solution enhanced the reactivity of both HCl and H2SO4.

EASI monitoring in ventricular tachycardia, an alternative to conventional electrocardiography?

Abstract Background 12-lead electrocardiogram (ECG) is the gold standard for detecting ventricular arrhythmias. In cardiac critical care units (UCC), monitoring systems are used to detect transient events such as arrhythmias or ST-segment acute changes. The discomfort caused in the patient by the need for 10 electrodes to obtain the 12 leads continuously means that complete monitoring is not routine. The EASI monitoring system, based on vector electrocardiography, is an alternative that uses only 5 electrodes (4 thoracic and 1 ground) and theoretically allows obtaining a complete standard ECG. Objectives The main endpoint of this study was to evaluate the diagnostic accuracy of the EASI monitoring system in patients with ventricular tachycardia (VT), compared with conventional ECG. Methods Seven cases of patients admitted to the CCU due to episodes of VT are presented. The patients were monitored with the EASI system upon arrival, and the conventional ECG and the one derived from the EASI system were taken simultaneously for VT events for comparison. The 4 electrodes of the EASI system were placed, as recommended, on the sternal manubrium (S), lower sternum at the level of the 5th intercostal space (E), at the level of the 5th intercostal space, and on the right and left midclavicular lines (I and A). Results Analysing case by case, the axis of the tachycardia was similar in 5 patients, being able to assess the origin of the tachycardia in them. In 2 patients it was different. These cases of patients that differ, one episode has its origin in the right ventricular outflow tract (endocardial) and the other in the area of the left ventricular summit (epicardial). Two patients with different tachycardias and no cardiac characteristics in common. Figure 1. Conclusions EASI monitoring is a feasible alternative for monitoring patients in the CCU, which could give us reliable information (compared with standard ECG) with limitations in some cases in which the cardiac axis differs. For patients admitted for arrhythmic events, a better characterization of the differences would be interesting in order to optimize its use.

Anatomical Variation of Sternal Angle and Body: a Cross sectional study

Background: The sternum is one of the important skeletal components ofthoracic case that frequently has congenital defects, and researchers routinely use variances to ascertain an individual's age and sex. Additionally, it helps the physician with biopsy procedures as well as therapy. The objective of this study was to evaluate the morphological characteristics of sternal body and sternal angle in both sexes. Method: This cross-sectional stuywas carried out at the Department of Anatomy, Sylhet MAG Osmani Medical College. For this purpose, 100 dried ossified sternums of unknown sex had been collected. The sample was collected in compliance with the inclusion and exclusion criteria. Discriminant function analysis was used to determine the sex of each sternum (DFA). Study variables were the maximum length of sternal body, maximum breadth of sternal body, thickness of the sternal body and sternal angle. Variables were measured using a vernier caliper and documented in a pre-designed data sheet. Result: The mean length of the body of sternum was 93.84±23.31 mm in male and 82.84±14.8 mm in female. The mean width of the body of the sternum was 35.3±10.83 mm in male and 29.22±9.65 mm in female. The thickness of the body of the sternum is 19.86±9.91 mm in males and 16.12±7.39 mm in females. Analysis revealed that length of body sternum, width of body of sternum and thickness of body of sternum were higher in male than female which was statistically significant (p<0.05).The mean angle of sternum was 148.29±8.240 degrees in males and 149.32±9.690degrees in females, respectively. The difference was statistically not significant (p<0.05). Conclusion: In females, the maximum sternal length, maximum sternal breadth, and maximum sternal thickness were all significantly lower.

Optimal Chest Compression Point During Pediatric Resuscitation: Implications for Pediatric Resuscitation Practice by CT Scans.

Current European guidelines for pediatric cardiopulmonary resuscitation (CPR) recommend the lower half of the sternum as the chest compression point (CP). In this study, we have used thoracic CT scans to evaluate recommended and optimal CP in relation to cardiac anatomy and structure. Analysis of routinely acquired thoracic CT scans acquired from 2000 to 2020. Single-center pediatric department in a German University Hospital. Imaging data were obtained from 290 patients of 3-16 years old. None. We measured and analyzed 14 thoracic metrics in each thoracic CT scan. In 44 of 290 (15.2%) scans, the recommended CP did not match the level of the cardiac ventricles. Anatomically, the optimal CP was one rib or one vertebral body lower than the recommended CP, that is, the optimal CP was more caudal to the level of the body of the sternum in 67 of 290 (23.1%) scans. The recommended compression depth appeared reasonable in children younger than 12 years old. At 12 years old or older, the maximum compression depth of 6 cm is less than or equal to one-third of the thoracic depth. In this study of thoracic CT scans in children 3-16 years old, we have found that optimal CP for CPR appears to be more caudal than the recommended CP. Therefore, it seems reasonable to prefer to use the lower part of the sternum for CPR chest compressions. At 12 years old or older, a compression depth similar to that used in adults-6 cm limit-may be chosen.

Practice Patterns in Sternal Closure and Evaluation of Adoption of a Novel Sternal Closure Device.

The technique for sternal closure has remained largely unchanged owing to the efficacy, simplicity, and low cost of stainless-steel sternal wires. Despite their ubiquity, several other closure devices designed to address the complications associated with sternal wires such as sternal bleeding and dehiscence have become popular. We have developed a novel sternal closure device that reduces sternal bleeding and dehiscence. This study quantifies the use of currently available sternal closure devices and determines predicted uptake of the novel device. An electronic survey, designed to determine practice patterns for sternal closure, was distributed to 70 US cardiac surgeons. The survey included a discrete choice section in which surgeons evaluated relative value of device attributes including cost, ease of emergent sternal reentry, and dehiscence risk. There were 70 surgeons from 30 states who completed the survey. The most frequent means of sternal closure was straight sternal wires (35.8%), followed by straight sternal wires plus figure-of-8 sternal wires (18.1%), double wires (10.9%), plates (10.2%), and other (25%). The relative utilization shifted from sternal wires to sternal plates as the risk for dehiscence increased. The adoption of the novel closure device was estimated at 34.6%. The standard stainless-steel sternal wire remains the most common means of sternal reapproximation, but its utilization is lower in patients at high risk for sternal dehiscence. Based on this survey, there is acceptance in the community for a novel sternal closure device designed to address the limitations of traditional sternal closure methods.

Assessing the reliability and accuracy of sex estimation models utilizing sternal morphometry derived from computed tomography in the Ghanaian population

Sex estimation models are specific to populations and cannot be generalized due to genetic and environmental variabilities. This retrospective cross-sectional study, conducted between January and September 2023 at the Tamale Teaching Hospital, included 119 (50.9 %) females and 115 (49.1 %) males aged 23–82 years. Measurements, including manubrium length (M), manubrium width (MW), sternal body length (B), combined manubrium and sternal body lengths (CL), corpus sterni width at first sternebrae (CSWS1), and corpus sterni width at third sternebrae (CSWS3), were obtained from Computerized Tomographic (CT) images of the sternum using DICOM Viewer, accurate to 0.1 cm. Subsequently, sternal area (SA) and sternal index (SI) were calculated. Univariable and stepwise multivariable discriminant function analysis (DFA) and logistic regression (LR) models were developed using a training sample (70 %), and cross-validation was performed on a holdout sample (30 %). Results showed that the linear measurements, excluding M, and sternal area were higher in males than females (P<0.001), while the sternal index was <50 % in males but >50 % in females (P<0.001). Univariable sex estimation accuracies, in cross-validation, ranged from 43.7 % to 92.9 % in DFA and 50.0–92.9 % in LR. For multivariable models, the accuracy ranges were 92.9–94.3 % in DFA and 91.6–93.0 % in LR. The sternal body length was the most accurate at 90.1 % in DFA and 90.2 % in LR, with lower sex bias (male-female) in LR than in DFA (-0.1 vs. 8.7). The sternum proves valuable for sex estimation, with sternal body length as the most accurate linear measurement. However, multivariable models, particularly LR, demonstrate higher accuracy compared to DFA.

Defining the imaging diagnostic criteria for adult chronic non-bacterial osteitis.

Osteitis of the sternocostoclavicular (SCC) region, referred to as sternocostoclavicular hyperostosis (SCCH), is the clinical expression of chronic non-bacterial osteitis (CNO) in adults with this rare chronic auto-inflammatory disorder of the axial skeleton. The diagnosis is based on distinctive computerized tomography (CT) features of sclerosis and hyperostosis of the SCC region, and local increases in osteoid formation visualized by high radiopharmacon uptake on skeletal scintigraphy but clear radiologic diagnostic criteria are lacking. In a cross-sectional study, CT scans and whole-body skeletal scintigraphy images obtained in 169 patients seen at the Center for Bone Quality of the Leiden University Medical Center between 2008 and 2018 with a suspected diagnosis of CNO of the SCC region were re-evaluated by 2 skeletal radiologists and 2 nuclear physicians. The diagnosis was confirmed in 118 (70%) predominantly female patients (n= 103, 89.2%); median age at first symptoms 45years (range 20-73). The diagnosis was excluded in the remaining 51 "non-CNO" patients. Increased radiopharmacon uptake at the SCC region was observed in 82% CNO patients, with the manubrium sterni having the highest predictive ability to discriminate on both imaging modalities. The prevalence of sclerosis of the clavicles, manubrium and first ribs was significantly higher in CNO patients (P< 0.001). Hyperostosis was not observed in non-CNO patients. 46 CNO versus only 2 non-CNO patients had costoclavicular ligament calcification. Our findings identify CT scan features of sclerosis and hyperostosis of manubrium sterni, medial end of clavicles and first ribs, and calcification of costoclavicular ligaments, associated with increased tracer uptake on skeletal scintigraphy at the SCC region, specifically manubrium sterni, as well-defined imaging diagnostic criteria for adult CNO. Pitfalls encountered in the diagnosis of CNO are highlighted. These defined imaging diagnostic criteria for adult CNO should facilitate the diagnosis of this rare auto-inflammatory bone disease across the spectrum of its early to late stages.

Radiographic and computed tomographic evaluation of tracheal diameter and length in kittens.

To measure the tracheal diameter and length in kittens using radiography and CT and to evaluate the concordance between measurements obtained with these 2 modalities. 15 kittens with an estimated age of 12 weeks and mean body weight of 1.49 kg. Radiographic and CT images were retrospectively evaluated to measure tracheal lengths and diameters. Tracheal diameters were measured at 5 different sites (A [at the level of the C2-3 intervertebral disk space], B [at the level of the C4-5 intervertebral disk space], C [at the cranial end of the manubrium sterni], D [at the level of the second rib], and E [1 cm cranial to the carina]) along the trachea. The cross-sectional area and transverse and vertical diameter ratios were calculated for each measurement site. The cross-sectional area was largest at site A and decreased from site C to site E. Based on the vertical diameter ratio, the tracheal shape was most circular at sites A and E, whereas from sites B to D, it was elliptical. The vertical diameters of the trachea on radiography and CT did not differ statistically significantly. However, the tracheal length measured on radiography was approximately 6 mm longer than that measured on CT (P < .05). Using the first rib as an anatomical reference, the placement of a cuffed endotracheal tube is recommended in kittens. In emergency situations, regression equations based on body weight may be helpful in predicting tracheal diameters.

Description of a new species of the Petrolisthesgalathinus complex from the Caribbean Sea, and resurrection of Petrolisthesoccidentalis from the East Pacific (Crustacea, Anomura, Porcellanidae).

The Petrolisthesgalathinus complex currently consists of six American species distributed in the West Atlantic, including the amphi-American P.galathinus. All species in the complex are similar in their adult morphology but differ in colour, size, larval morphology, and shape of the adult sternal plate. The West Atlantic species have different geographic ranges, which overlap in the southern Caribbean. Previously published molecular data support the monophyly of the complex, and the reciprocal monophyly of each described species and further clades corresponding to different colour morphs. Here, the morph P.caribensis "Blue" is described as Petrolisthescoeruleussp. nov., and Petrolisthesoccidentalis is formally resurrected for the Pacific individuals of P.galathinus. By adding these two species to the P.galathinus complex, this now consists of eight species. Colour illustrations of all species and colour morphs are provided and their geographic distributions and ecological ranges are discussed and updated.

Mediastinal Tuberculosis with Sternal Encroachment - A Rare Presentation of Tuberculosis

Introduction Extra-pulmonary tuberculosis constitutes 15-20% of the total tuberculosis (TB) caseload in immunocompetent patients. Affliction of the skeletal system is rare with still rarer presentation of sternal tuberculosis. Sternum is one of the least common bones of the body to get infected (1) Sternal TB is predominantly seen in middle-aged adults although no age is immune and it has also been reported in an infant. It can arise primarily due to a hematogenous route or direct extension from the hilar lymph nodes and/or could be due to lymphatic disseminatio(2) . Sternal tuberculosis has also been reported after BCG vaccination in the pediatric age group (3-5) Here we present an unusual case of tuberculosis of the sternum, which presented with swelling and pain in the chest in a 9 year old boy. Keywords: Sternal tuberculosis, Manubrium sterni, Skeletal Tuberculosis, Pediatric sternal tuberculosis, Mediastinal Koch’s

Presence of manubrium-sternum joint does not assure sufficient elevation of sternum in Nuss procedure for pectus excavatum patients.

The manubrium and body of the sternum are connected by the manubrium-sternum joint (MSJ). In performing the Nuss procedure for pectus excavatum patients, the body of the sternum is elevated as the operator flips correction bars upside down. Theoretically, the presence of the MSJ should allow elevation of the sternum body. However, does the MSJ secure sufficient elevation of the sternum? This study aims to elucidate this clinical question. Seventy-four adult pectus excavatum patients with moderate to serious deformity (with Haller Index being equal to or greater than 5) were included in the study. The MSJ was open in all patients. For 29 patients, the sternum was elevated by only bar flipping (Non-Separation Group); for 45 patients, the sternum was horizontally separated after bar flipping (Separation Group). Whether or not additional elevation for Separation Group patients results from the division was observed, and the degree of the additional elevation was evaluated. Furthermore, 74 patients subjectively evaluated postoperative pain and gave scores with a Visual Analog Scale ranging from 0 (no pain) to 10 (intolerable pain). The VAS scores were compared between the two groups. In the Separation Group, the sternums of all patients achieved additional elevation from sternum separation. The pain scores were lower for the Separation Group than for the Non-Separation Group. Even when the MSJ is present, horizontal separation enhances the elevation of the sternum. Furthermore, horizontal separation of the sternum reduces postoperative pain.

Sternal Tuberculosis: About Two Senegalese Cases

Tuberculosis (TB) remains a major public health problem in resource-limited countries where it is endemic. Sternal TB is a rare entity. It accounts for less than 1% of tuberculous osteomyelitis.&#x0D; We report two cases of sternal TB occurring in two young Senegalese aged 21 and 23, who presented with inflammatory sternal swelling in the context of evening raise of temperature and weight loss. In both cases, Mycobacterium tuberculosis was detected in the pus specimen using the Genexpert® MTB/RIF test (Cepheid, California). In one case, a chest CT scan revealed lysis of the sternal manubrium. The patient's condition improved with anti-tuberculosis treatment and surgery.&#x0D; These cases, particularly in areas where tuberculosis is endemic, highlight the importance of considering tuberculosis as a possible cause of sternal tumefaction.

A new pterosaur from the early stage of the Jehol biota in China, with a study on the relative thickness of bone walls

The Huajiying Formation (135.4–128.7 Ma) of the northern Hebei represents the early stage of the Early Cretaceous Jehol Biota in China, yielding many kinds of vertebrates. The only known pterosaur specimen was incomplete and assigned to the Ornithocheiroidea. Here we report a more complete pterosaur specimen, assigned to the Ctenochasmatidae. A new taxon is established on two autapomorphies: a large pneumatic foramen present on the ventral surface of the proximal end of the first wing phalanx; and coracoid lacking an expansion at its contact with the scapula, as well as the following combination of characteristics: subsquare sternal plate; coracoid having an extremely concave articulation with a posterior expansion; humerus without a tubercle on the proximal margin between the deltopectoral crest and the head; humerus slightly longer than the wing metacarpal; and the first and third wing phalanges equal in length. The relative thicknesses of bone walls are investigated among pterosaurs in three ways. The overall distribution of R/t ratios shows that most non-pterodactyloids, archaeopterodactyloids, and dsungaripterids have smaller R/t ratios than other groups. Relatively thick bone walls are not unique for the Dsungaripteridae as previously thought, and the humerus and radius of dsungaripterids have thinner walls than other bones. The feature of small R/t ratios is plesiomorphic and the thin-walled humerus and radius of dsungaripterids were evolved to meet the need of the flight, not for frequent take-off and landing as previously thought.

MANUBRIAL INDEX–A RELIABLE GUIDE IN DETERMINING THE SEX OF THE STERNUM

Objective: Sexing an unknown skeleton is a very important and difficult process that anatomists and jurists have to fulfill. Sex can be predicted by the sternum with 90% accuracy. It is crucial to predicting age in the middle age range and sternum is particularly useful for it. In the study conducted for sexing the sternum, different measurements were compared and it was found that manubrium alone is a good tool for gender differentiation of the sternum. Methods: Study was conducted on 100 Sternums of known age and sex which were collected from the postmortem room of the forensic department after taking due consent from the attendants of the deceased. Different measurements of manubrium were taken and contrasted for gender differentiation. ANOVA was used to evaluate the statistical significance. Results: It was found that among morphometric criteria of prosternum manubrial index was found to be accurate and reliable along with clear-cut demarcation in length and width of the manubrium sterni of two sex. Conclusion: It was concluded by this study that the manubrial index is a trustworthy tool for sexing sternum and manubrial width could be fairly reliable criterion for determining sex of the sternum.

Infective Costochondritis after Augmentation Mammoplasty: A Rare Case Report and Review of the Literature.

Silicone breast implant insertion is a commonly performed surgical procedure for breast augmentation or reconstruction. Among various postoperative complications, infection is one of the main causes of patient readmission and may ultimately require explantation. We report a case of infective costochondritis after augmentation mammoplasty, which has rarely been reported and is therefore difficult to diagnose. A 36-year-old female visited the clinic for persistent redness, pain, and purulent discharge around the left anteromedial chest, even after breast implant explantation. Magnetic resonance imaging showed abscess formation encircling the left fourth rib and intracartilaginous and bone marrow signal alteration at the left body of the sternum and left fourth rib. En bloc resection of partial rib and adjacent sternum were done and biopsy results confirmed infective costochondritis. Ten months postoperatively, the patient underwent chest wall reconstruction with an artificial bone graft and acellular dermal matrix. As shown in this case, early and aggressive surgical debridement of the infected costal cartilage and sternum should be performed for infective costochondritis. Furthermore, delayed chest wall reconstruction could significantly contribute to the quality of life.

Composite hemangioendothelioma- report of two cases located in bone and review of the literature

BackgroundComposite hemangioendothelioma (CHE) is a rare intermediate-grade vascular tumor characterized by a complex histologic component. It occasionally metastasizes, but local recurrence is not uncommon. CHE is mainly located in the extremities’ distal dermis and subcutaneous soft tissues. It is rarely located in the bone. We report here two cases originally occurred in bone.Case presentationThe first case of CHE occurred solely on the left pubis. The second case is a patient post-resection of CHE in the manubrium sterni 10 years ago [1], who presented with multiple lesions in the left ilium and T6, T12 vertebra. All these lesions in the two cases showed osteolytic bone destruction on computed tomography (CT) scans and showed relatively high signal intensity on the fat-suppressed sequences of T2-weighted magnetic resonance (MR) images and isointense signal intensity on T1-weighted MR images. After injection of contrast agent (Gd-DTPA), the lesions showed inhomogeneous enhancement. 2-deoxy-2 [F-18] fluoro-D-glucose positron emission tomography-computed tomography (18FDG PET-CT) showed increased FDG uptake in these osteolytic bone destruction areas with SUVmax around 5.0. Both patients underwent surgery. Lesions in the left pubis and left ilium were confirmed by postoperative pathology while lesions on the vertebrae were only biopsied, not surgically resected. The first patient had no recurrence or metastasis in 5 years after surgery. The second patient had surgery recently and is still being followed up.ConclusionsCHE occurring in bone is rarely reported. Our report provides more detailed information on the diagnosis of CHE. Given that CHE is locally aggressive and occasionally metastatic, PET-CT may be helpful in staging and follow-up.

Chest Tube Insertion Following a Failed Needle Decompression in a Patient with Tension Pneumothorax: a Case ReportChest tube insertion following a failed needle decompression in a patient with tension pneumothorax: A case report

Pneumothorax occurs when the pleural space is filled with air due to trauma, iatrogenic injury, or underlying lung disease. If this air leak forms a one-way valve that causes air to be trapped, an uncontrolled increase in air volume can occur, causing lung collapse and shift of the mediastinum to the contralateral side, which can eventually cause respiratory and hemodynamic disturbances or even death. Here, we report a 46-year-old male patient who came to the hospital complaining of shortness of breath and chest pain radiating to the left shoulder. On physical examination, the patient had severe shortness of breath, tracheal deviation, decreased expansion and air entry of the left hemithorax, hyperresonance of the left hemithorax, and a shift of the punctum maximum of the heart sounds to the left sternal line. The chest x-ray performed on the patient confirmed the suspicion of a tension pneumothorax. A needle decompression in the 2nd intercostal space in the left midclavicular line failed to improve the tension pneumothorax. A chest tube insertion was performed which managed to improve the patient's clinical condition.

Anatomical variations of the sternum: sternal foramen and variant xiphoid morphology in dried adult human sternum in Ethiopia.

Background: The sternum exhibits unique anatomical variations with major clinical and forensic implications. This study is devoted to providing baseline epidemiological information about the sternal foramen and variant xiphoid morphology in Ethiopia. Two extremely interesting and unusual variations of the sternal foramen are also discussed. Methods: This observational study was carried out using dried adult human sternum obtained from skeletal remains samples brought for medicolegal examination over a period of 4 years. A total of 94 dried adult human sternums (66 males (70.2%) and 28 females (29.8%)) were obtained with an age range of 21 to 57 years and a mean age at death of 38.383 ± 11.3480 years. Dried human sternum specimens were morphologically examined, and morphometric parameters were recorded and photographed. Results: A sternal foramen was found in 18 specimens (19.1%); 17 were male and one was female. A single sternal foramen was observed in 83.3% (n=15/18) of the sternal bodies and 11.1% (n=2/18) of the xiphoid processes (both males). In addition, a double sternal foramen was observed in a single male specimen on the mesosternum and xiphoid process. The most common sternal foramen site was at the fifth costochondral junction level. The xiphoid process was present in 77 samples and ended as a single process in 83.1% (n=64/77) of samples. In 15.6% (n=12/77) of the samples, the xiphoid process was bifurcated and trifurcated in a single male (1.3%) specimen. Conclusions: The sternal foramen and variation in xiphoid morphology are common anatomical variations in Ethiopia. The findings of the current study highlight the necessity of strict precautionary measures during sternal procedures in this study population. In addition, such incidental findings during radiologic and autopsy procedures should be properly evaluated to avoid misdiagnosis and misinterpretation of such findings as traumatic or pathologic conditions.