B46-13 The Great Escape: Migration of a Sternal Wire Into the Lung Parenchyma and Pericardium - A Case Report

Sternal wire migration is a rare but potentially fatal complication following median sternotomy. We describe operative management of a 55-year-old male with coronary artery disease, ischemic cardiomyopathy (EF 40-45%), and prior CABG (LIMA-LAD, SVG-PLOM, SVG-PDA, 2021) presented with progressive dizziness and a 1.5-cm soft swelling adjacent to his sternotomy scar. The swelling enlarged when supine but was nontender at rest. CT chest demonstrated multiple fractured sternal wires—one protruding into the anterior chest wall and another extending into the anterior pericardium with possible involvement of the right atrial and ventricular walls. Transthoracic echocardiogram showed EF 40-45% with grade I diastolic dysfunction and no effusion. He was admitted for evaluation and operative planning. Under general anesthesia, a resternotomy was performed with fluoroscopic guidance. Several fractured wires were removed from the subcutaneous and sternal planes. Dense fibrotic tissue and nonunion were observed at the lower sternum. Due to the risk of right ventricular perforation, removal of the pericardial wire was aborted. The sternum was re-approximated and reinforced with three titanium plates. Intraoperative transesophageal echocardiography showed EF 50-55% and no pericardial effusion, ruling out cardiac tamponade or ventricular wall rupture. Postoperatively, the patient’s chest discomfort resolved. He was discharged on postoperative day three with lifting restrictions and close follow-up. At his two-week cardiothoracic visit, the incision was healing well and the sternum stable. At family medicine follow-up, dizziness persisted but chest wall swelling had resolved. Repeat echocardiography demonstrated stable cardiac function with no effusion or migration. This case illustrates delayed sternal wire migration presenting four years post-CABG. Chronic nonunion and repetitive mechanical stress likely contributed to fracture and migration. Although complete removal is ideal, conservative retention of high-risk fragments may be justified. If there is clinical suspicion in patients who have undergone prior sternotomy, regular clinical and imaging surveillance may be considered to monitor for late complications such as pericardial effusion or cardiac tamponade. This case underscores the importance of imaging in post-sternotomy patients presenting with atypical chest findings and highlights the role of individualized management when removal poses high risk. This abstract is funded by: None