This Article Full Text Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Weir, R. A.P. Articles by Roditi, G. H. Search for Related Content PubMed PubMed Citation Articles by Weir, R. A.P. Articles by Roditi, G. H. Pubmed/NCBI databases Medline Plus Health Information Coronary Artery Bypass Surgery CT Scans Related Collections Cardiovascular imaging agents/Techniques CT and MRI CV surgery: other

(Circulation. 2008;118:e673-e674.)
© 2008 American Heart Association, Inc.

Images in Cardiovascular Medicine

Bursting Forth

Late-Developing Acute Mediastinal Abscess After Sternotomy Demonstrated by Cardiac Computed Tomography

Robin A.P. Weir, BSc(Hons), MBChB(Hons), MRCP; Ross MacDuff, BSc, MBChB, MRCP; Udim U. Nkere, MD; Giles H. Roditi, MBChB, FRCR

From the Cardiology Department (R.A.P.W.), Radiology Department (R.M., G.H.R.), and Department of Cardiothoracic Surgery (U.U.N.), Royal Infirmary, Glasgow, UK.

Reprint requests to Robin A.P. Weir, Cardiology Department, Royal Infirmary, Castle St, Glasgow G4 0SF, Scotland, UK. E-mail robinweir75@hotmail.com

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 77-year-old man presented with a 5-week history of night sweats, intermittent fever, weight loss, and general malaise. He had undergone coronary artery bypass graft surgery 6 years previously in which the left internal mammary artery was grafted onto the left anterior descending artery and reverse saphenous vein conduits were grafted onto the right coronary artery, circumflex coronary artery (Cx), and first obtuse marginal branch (OM1). A tender soft tissue swelling had arisen at the left anterior chest wall. Observations revealed a pyrexia of 39°C, pulse of 102 bpm regular, and blood pressure of 121/62 mm Hg. Clinical examination revealed a prominent, pulsatile, soft tissue swelling overlying the third left intercostal space adjacent to the superior margin of his sternotomy scar (Figure 1 and the Movie in the online Data Supplement). Blood chemistry revealed an elevated white blood cell count (11.6x10⁶/mL) and C-reactive protein (125 mg/L). Chest x-ray revealed widening of the superior mediastinum. Blood cultures failed to grow any pathogenic bacteria.

View larger version (89K):   Figure 1. Clinical photograph of the protruding soft tissue swelling in the left upper anterior chest. A, Oblique left anterior view shows the proximity of the swelling to the sternotomy scar. B, Left lateral view exhibits the degree of protrusion from the anterior chest wall. See the Movie in the online Data Supplement.

A bolus-tracked arterial phase contrast–enhanced computed tomogram (CT) of the chest (40–detector row scanner with 100 mL Iomeron 400) revealed a large nonenhancing multilocular fluid collection in the anterior mediastinum extending . . . [Full Text of this Article]