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Resident PGY 4
Henry Ford Hospital
Our patient was an 81 year-old female with a history of multiple esophageal dilations with a large distal esophageal perforation, status post fully covered metal stent placement. CT Thorax showed a mediastinal fluid collection exerting mass effect on the right heart, incidental note was made of a sternal foramen (Panel 1, arrow). Interventional Radiology was consulted for drainage. Utilizing Seldinger technique, a 5-Fr introducer (Panel 2) followed by a 10-Fr catheter was placed through the sternal foramen and into the mediastinal fluid collection. The fluid collection was aspirated with resolution of mass effect on the heart. (Panel 3, catheter traversing the sternal foramen after aspiration of the collection. Distal portion of the catheter is out of the image plane). A sternal foramen is a developmental variant that is present in approximately 5% of the population and results from incomplete fusion of the sternal ossification centers. In this case it allowed safe percutaneous drainage of the mediastinal fluid collection, avoiding risk of injury to the internal mammary vessels or intervening lung parenchyma which could have occurred with a parasternal approach. (Figures/panels will be submitted with final submission)
Joshua, Joseph and Bonnett, John, "Take a Stab at It! Percutaneous drainage via normal variant sternal foramen" (2020). Case Reports. 73.