A Closer Look at the Midsternal Stripe Sign
Phillip M. Boiselle1 and
Alberto V. Mansilla2,3
1
Department of Radiology, Harvard Medical School and Beth Israel Deaconess
Medical Center, 330 Brookline Ave., Boston, MA 02215.
2
Department of Radiology, Temple University Hospital, 3401 N. Broad St,
Philadelphia, PA 19106.
3
Present address: Department of Radiology, Florida Hospital, 601 E. Rawlings
St., Orlando, FL 32806.
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Fig. 1. —Line drawing shows normal appearance of postoperative sternum
and radiographic signs of dehiscence, including displacement (displaced wires
are highlighted in bold print) and midsternal stripe (wires have been removed
from drawing for simplification). It has been proposed that mechanism of
dehiscence involves sternal wires pulling or cutting through sternum rather
than breaking. As sternum separates, some wires (bold print) travel with right
side of sternum whereas others migrate with left side of sternum. Cleft
between two sternal fragments is rarely visualized radiographically as midline
radiolucency or stripe. (Illustration adapted with permission from
[5])
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Fig. 2. —Midsternal stripe sign is visualized in 61-year-old man after
median sternotomy and coronary artery bypass surgery. Coned-down radiograph of
mediastinum from portable chest radiograph reveals midsternal radiolucency
(paired arrows) measuring slightly less than 3 mm at greatest width.
Sternal wires show normal alignment in vertical row with no significant
displacement. (This radiograph of patient in study cohort was not one of
images reviewed for study because it was obtained after sternal rewiring for
dehiscence; however, it was selected for illustrative purposes because of
highly visible stripe and sutures.)
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Fig. 3. —Midsternal stripe sign is visualized in 67-year-old man who
developed sternal dehiscence after median sternotomy for repair of type I
aortic dissection. Coned-down image of lower mediastinum from portable chest
radiograph shows wide midsternal stripe (paired black arrows)
corresponding to cleft between two sternal fragments. Note rightward
displacement of lower sternal wires (right lateral margin demarcated by
open black arrows) with respect to more proximal wire (right lateral
margin demarcated by closed white arrow).
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Fig. 4. —Sternal wire displacement is revealed in 66-year-old man who
developed sternal dehiscence after coronary artery bypass surgery. Portable
chest radiograph shows marked rightward displacement of first three sternal
wires with respect to lower three sternal wires. Wide radiolucent cleft (right
margin demarcated by arrows, left margin extends to midline adjacent
to lower sternal wires) is visible between sternal fragments; stripe projects
to right of midline because of rightward patient rotation (note asymmetry of
clavicles). Sternal wires have been highlighted with black marker to improve
visualization.
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Copyright © 2002 by the American Roentgen Ray Society.
