Sternal foramina: An imaging study.

To investigate the computed tomography (CT) image characteristics, adjacent tissues, and related measurement indices of the sternal foramina and provide an anatomical basis for the safety of minimally invasive sternum surgery. The data from 2500 thoracic multi-slice computed tomography (MSCT) cases from January 2020 to June 2021 were analyzed retrospectively. The number and location of the sternal foramina and adjacent tissues (mediastinal adipose tissue, lung, pericardium) were observed. The size of the sternal foramina, CT value of the tissue inside the foramina, subcutaneous adipose tissue thickness, distance from skin to lung, distance from skin to the pericardium, and manubrio-foraminal distance were measured. Sex differences were compared for each indicator performed. The incidence of sternal foramina was 4.44% (111/2500), with 83 males and 28 females. All sternal foramina were located at the mesosternum's fourth to sixth costal cartilage level. The transverse diameter of the sternal foramina was (0.60 ± 0.29) cm, and the vertical diameter was (0.68 ± 0.39) cm, which was greater in males than females (p > 0.01). The CT value of the tissue in the sternal foramina was (-77.05 ± 32.26) Hu, and there was no statistical difference between male and female patients (t = -1.780, p = 0.078). The adjacent tissues of the sternal foramina were only adjacent to adipose tissue in 41 cases (36.94%), pericardium in 18 patients (16.22%), lung tissue in 37 cases (33.33%), and both kinds of tissue in 15 cases (13.51%). The sternal foramina were not adjacent to the left lung in the female patients. In the sternal foramina region, the thickness of subcutaneous adipose tissue was (1.13 ± 0.51) cm, the distance from skin to lung was (1.86 ± 0.57) cm, the distance from skin to pericardium was (3.07 ± 0.72) cm, the manubrio-foraminal distance was (12.68 ± 1.31) cm, which was significantly greater in males than in females (p < 0.05). The sternal foramina are closely related to the heart and lungs. The size and location of sternal foramina, the thickness of subcutaneous adipose tissue, and the distance from skin to heart and lung are all crucial factors in evaluating the safety of sternal puncture biopsy.

The safe zone for blinded sternal interventions based on CT evaluation of midline congenital sternal foramina.

OBJECTIVE: The aim of this study was to evaluate the safe zone for performing blind sternal procedures based on computed tomography (CT) evaluation of congenital midline sternal foramina using multidetector computed tomography (MDCT). MATERIALS AND METHODS: This retrospective study was carried out on 1,180 patients who underwent MDCT of the thorax from March 2015 to February 2016. The MDCT images were evaluated in axial and reformatted planes. Morphometry and prevalence of midline congenital sternal foramina (SF) and manubrio-foraminal distance (MFD) were evaluated. The safe zone was defined for a blinded intervention, based on palpable anatomical landmarks. Data were presented in terms of percentage, mean ± standard deviation and calculations were carried out using Microsoft Excel. RESULTS: The prevalence of SF in our study sample was 11.6 %. The majority of SF were located in a typical position in the lower sternal body at the level of fifth costo-chondral junction (CCJ) in 108 patients (78.8 %). The structure directly beneath the SF was mediastinal fat in 73 patients (53.3 %), followed by anterior pericardium in 44 patients (32.1 %) and lung parenchyma in 20 patients (14.6 %). The mean MFD in our study population was 11.90 ± 1.31 cm. CONCLUSIONS: Sternal interventions should be avoided at the level of fourth to sixth CCJ, which is considered the danger zone. An intervention at the fourth to sixth CCJ may lead to disastrous consequences in patients who have SF.

Clinical Relevance of Sternal Foramina: A Morphometric Study.

Objectives: The present study aimed at determining the incidence of sternal foramina in adult dry bones of North Indian descent. We also aimed to determine the number, precise location of the sternal foramina with a standard reference point which might have considerable importance with regard to procedures involving sternal puncture. Methods: This cross sectional descriptive study was conducted on 72 dry adult human sternums. Various measurements in relation to the sternal foramina were taken with a non-stretchable measuring tape and digital vernier calliper and expressed as: [A]-total sternal length, [B]-distance between the jugular notches to the foramen, [C]-distance between the angle of Louis to the foramen and [D]-distance of the foramen from the mid sternal plane. Statistical analysis was performed with Microsoft Excel version 2019. A p-value of <0.05 was considered significant. Results: We found 6.94% (5 out of 72 sternums) incidence of sternal foramina which corroborates well with the existing literature. Mean sternal length was 127.7 ± 09 mm. The mean distance of the foramina from suprasternal notch, sternal angle and from the median plane were 118.12 ± 0.3 mm, 116.7 mm and 2.4 mm respectively. Incidence of sternal foramina was almost similar to previously reported studies. Conclusions: The precise knowledge about the expected location of sternal foramina is imperative to avoid intra-thoracic visceral injury during commonly performed acupuncture needle insertion and while doing bone marrow aspiration for diagnostic evaluation.

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.

High prevalence of sternal foramina in indigenous Bolivians compared to Midwest Americans and indigenous North Americans (sternal foramina in indigenous Bolivians).

The sternal foramen, usually an asymptomatic osteological defect, can lead to catastrophic consequences if not recognized prior to certain medical procedures. This study reports the prevalence of a sternal foramen in two South Amerindian populations compared with other published populations. We evaluated the presence of sternal foramina using thoracic computed tomography scans of 1334 (48% female) participants from two indigenous populations of Bolivia (n = 900 Tsimane, 434 Moseten). The prevalence of sternal foramina was compared to two U.S. populations of similar sex/age distribution (n = 572 Midwest Americans, 131 self-identified Native North Americans) via similar CT scans. A sternal foramen was significantly more common in the two Bolivian populations (prevalence ranging from 12.8 to 13.4%), compared to 4.4-5.1% in the two U.S. groups, consistent with prior estimates in studies from industrialized populations. Males had higher frequency of a sternal foramen compared to females in each of the four groups (OR = 1.904, 95% CI: 1.418-2.568, p < 0.001). Age was not associated with sternal foramen presence. These data show both a higher rate of sternal foramina in the South Amerindian populations versus comparator populations in North America and the highest rate of any studied living population. Although it is not possible to determine from our data the relative contribution of genetics versus early life or environmental causes to the higher rates of sternal foramen, we note that small prior studies have likewise demonstrated a higher prevalence in lower income countries. Further determination of the contributing factors warrants greater investigation and research.

MDCT evaluation of sternal variations: Pictorial essay.

Sternal variations and anomalies have been identified in the past during autopsy or cadaveric studies. Recently, an increasing number of minor sternal variations have been reported with the advent of multidetector computed tomography (CT). Although there are many sternal variations that occur with varying appearance and prevalence, most of them are not recognized or are underreported during routine imaging of thorax. Identification of sternal variations is important to differentiate from pathological conditions and to prevent fatal complications prior to sternal interventions like marrow aspiration or acupuncture. This article aims to describe the minor and asymptomatic sternal variations by multidetector CT and their clinical significance.

Congenital sternal foramen in a stillborn Holstein calf.

Congenital sternal foramen is an anomaly whose occurrence is rare in human but is especially unusual in animals. This defect was formed when fusion of multiple ossification centers was incomplete. It may be associated with other lesions in body organs especially cardiac anomalies. In the present study, we report a very rare case of congenital sternal foramen in a Holstein calf. The oval defect was like a gunshot wound and located at the lower third of the sternum. Apparently, the rest of skeleton system seems normal. The awareness of the anomaly is important for better diagnosis and treatment of diseases.

High prevalence of sternal foramen: quantitative, anatomical analysis and its clinical implications in acupuncture practice / Alta prevalencia del foramen esternal: análisis cuantitativo y anatómico y sus implicancias clínicas en la práctica de la acupuntura

The aim of our study was to verify the prevalence of the sternal foramen in adult cadavers and dry bones, as well as to determine its exact localization and relation to acupuncture points. One hundred eighty sternums fixed and contained in 10 percent formaldehyde solution were examined, of which 100 were dry bones and 80 belonged to adult cadavers. The morphometric measures were expressed in millimeters when measuring the length: 1) from jugular incision to the foramen (JI-F); 2) from sternal angle to the foramen (EA-F); 3) from xiphoid process to the foramen (XP-F). Statistical analysis was performed to compare expected vs obtained foramina frequency, using Fisher's test (p0.05 was considered significant). The results showed 16.6 percent sternal foramina, significant higher than expected (p0.0248). Of the 30 foramina, 53.3 percent were found in cadavers, of which one was a woman, and 46.7 percent sternums were found in dry bones. Of the cadavers with sternal foramen, 10 foramina were at the 5th sternochondral articulation level and 6 foramina at the 4th sternochondral level. Of the 14 analyzed dry bones, 9 foramina were at the space between the 4th and the 5th costal pit level and 5 foramina were at the 5th costal pit level. The mean±SD (mm) total length of the sternums was 151.8+/-34 and the measures JI-F, EA-F, and XP-F were, respectively, 103.8+/-22.1mm, 65.6+/-15mm and 46.9 +/-15mm. Knowledge of this occurrence is important to avoid serious heart injury by needle insertion, especially as this area holds a commonly used acupuncture point and sternal puncture...

El objetivo del estudio fue verificar la prevalencia del foramen esternal en cadáveres adultos y huesos secos, así como, determinar su localización y su relación con los puntos de acupuntura. Fueron examinados 180 esternones fijados en solución de formol al 10 por ciento, 100 eran huesos secos y 80 pertenecían a cadáveres de individuos adultos. Las medidas morfométricas se expresaron en milímetros, efectuándose las siguientes mediciones: 1) desde la incisura yugular al foramen; 2) desde el ángulo esternal al foramen y 3) desde el proceso xifoides hasta al foramen. El análisis estadístico permitió comparar la frecuencia de los forámenes, usando el test de Fisher (p 0,05 ). Los resultados mostraron la presencia del foramen esternal en 16,6 por ciento de los casos, siendo significativamente mayor a lo esperado (p 0,0248). De los 30 forámenes, el 53,3 por ciento se encontró en cadáveres y en el 46,7 por ciento en los huesos secos. De los cadáveres con foramen esternal, 10 forámenes se encontraban a nivel de la 5 articulación esternocondral y 6 a nivel de la 4 articulación esternocondral. De los 14 forámenes de los huesos secos, 9 forámenes se encontraban entre entre el 4 y el 5 espacio intercostal y 5 se localizaban a nivel del 5 articulación. La longitud total del esternón fue 151,8 mm +/- 34 y las medidas desde la incisura yugular al foramen, desde el ángulo esternal al foramen y desde el proceso xifoides hasta al foramen fueron, 103,8 +/- 22,1 mm, 65,6 +/- 15 mm y 46,9 +/- 15 mm, respectivamente. El conocimiento de este hecho es importante para evitar la lesión cardiaca grave por la inserción de agujas, ya que esta zona tiene un punto de acupuntura de uso común en la punción esternal...