Successful surgical treatment of traumatic sternal fracture with extensive mediastinal abscess and concomitant mitral va
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CASE REPORT
Open Access
Successful surgical treatment of traumatic sternal fracture with extensive mediastinal abscess and concomitant mitral valve endocarditis: a case report Hiroshi Munakata1* , Yu Murakami1, Katsuhito Mabuni1, Hiroyuki Tsuchiya2, Moriaki Shinzato2, Takehiro Umemura2 and Tadao Kugai1
Abstract Background: A traumatic sternal fracture with extensive mediastinal abscess and concomitant native valve endocarditis is an extremely rare but catastrophic situation. Case presentation: For 2 weeks, the co-infected patient was treated with aggressive debridement for the mediastinitis, change of vacuum-assisted closure therapy dressings, vegetectomy and valve repair through lower partial sternotomy, and delayed primary wound closure. Conclusions: To the best of our knowledge, this successful staged strategy has not been previously reported. We believe that our quick decision about repeated surgical interventions and preservation of the manubrium led to a favorable result. Keywords: Traumatic sternal fracture, Mediastinitis, Endocarditis, Aggressive debridement, Successfully staged strategy
Background A mediastinal abscess because of a primary traumatic sternal fracture is uncommon in healthy individuals [1, 2]. Additionally, native valve endocarditis with concomitant sternal mediastinitis is an extremely rare but catastrophic situation. To the best of our knowledge, this catastrophic situation has not been previously reported, nor has a successful strategy been employed to manage this situation; hence, we report a successful surgical strategy for this serious, co-infected case. Case presentation The patient was an 87-year-old healthy female with only a medical history of hypertension. One month earlier, she experienced blunt chest trauma. During this period, general malaise and intermittent fever occurred. * Correspondence: [email protected] 1 Department of Cardiovascular Surgery, Okinawa Prefectural Nambu Medical Center and Children’s Medical Center, Haebaru, Japan Full list of author information is available at the end of the article
Initially, the patient was admitted to another emergent hospital because of excruciating chest pain and severe dyspnea. Emergent computed tomographic (CT) scan demonstrated a transverse mid-body fracture of the sternum with surrounding fluid collection. The patient was transferred to our institution with a diagnosis of traumatic sternal fracture with mediastinal abscess. On admission to our institution, the patient had high grade fever. Initial laboratory data demonstrated a white blood cell (WBC) count of 25,100/uL and C-reactive protein (CRP) of 340 mg/L. Blood culture was positive for Gram-positive cocci in clusters and vancomycin was immediately started. A few days after admission, her inotropic requirement increased progressively as her hemodynamic status deteriorated. She was endotracheally intubated and follow up images showed progressive changes. The abscess could be seen extending to both the anterior and posterior aspects of the fractured sternum and to th
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