Morphological approach of the sternal foramen: an anatomic study and a short review of the literature

• Autorzy: Gkantsinikoudis N. , Chaniotakis C. , Gkasdaris G. , Georgiou N. , Kapetanakis S.
• Języki publikacji: EN

Abstrakty

EN

Background: The sternal foramen (SF) constitutes a specific anatomic defect in sternum, indicating an impaired fusion of ossificated segments, which occurs either in an anatomical part of the sternum or in sternal joints. The aim of this article is to provide baseline statistical data about the variations of the SF, to present a short review of the relevant literature and to compare results with other studies and populations. Materials and methods: We review relevant literature, and we present data obtained from skeletal samples of known population and sex. A total of 35 well-preserved dried sterna from the prefecture of Eastern Macedonia and Thrace, Greece, were selected: 20 men and 15 women with a mean age of 55 ± 6 years old. Measurements were made with a sliding calliper and photographic documentation. Results: The incidence of the SF in the 35 dried specimens was 14.2%, 4 men (20% of male sample) and 1 woman (6.6% of female sample) and 80% of sternal foramina were observed in male individuals. The SF was found in the sternum body (2 cases, 40% of foramina), in xiphoid process (2 cases, 40% of foramina) and in sternoxiphoidal junction (1 case, 20% of foramina). All of the sterna presented 1 single visible SF. Two anatomically unique cases were identified throughout these 5 sterna, both belonging in male subjects. Conclusions: The SF constitutes a relatively common variation with great radiological, clinical, and forensic significance. Presence of a SF with irregular bony margins complicates considerably radiological differential diagnosis. Awareness of this important anatomic variation is fundamental for clinicians and autopsy pathologists, in order to avoid severe fatal complications and elucidate the exact cause of death, respectively. (Folia Morphol 2017; 76, 3: 484–490)

• Wydawca: -
• Czasopismo: Folia Morphologica
• Rocznik: 2017
• Tom: 76
• Numer: 3
• Opis fizyczny: p.484-489,fig.,ref.

Twórcy

autor

Gkantsinikoudis N.

• Department of Anatomy, Medical School, Democritus University of Thrace, Alexandroupolis, Greece

autor

Chaniotakis C.

• Department of Anatomy, Medical School, Democritus University of Thrace, Alexandroupolis, Greece

autor

Gkasdaris G.

• Department of Anatomy, Medical School, Democritus University of Thrace, Alexandroupolis, Greece

autor

Georgiou N.

• Department of Anatomy, Medical School, Democritus University of Thrace, Alexandroupolis, Greece

autor

Kapetanakis S.

• Department of Anatomy, Medical School, Democritus University of Thrace, Alexandroupolis, Greece

Bibliografia

• 1. Akin K, Kosehan D, Topcu A, et al. Anatomic evaluation of the xiphoid process with 64-row multidetector computed tomography. Skeletal Radiol. 2011; 40(4): 447–452, doi: 10.1007/s00256-010-1022-1, indexed in Pubmed: 20721551.
• 2. Ashley GT. The relationship between the pattern of ossification and the definitive shape of the mesosternum in man. J Anat. 1956; 90(1): 87–105, indexed in Pubmed: 13295154.
• 3. Babinski M, Rafael F, Steil A, et al. High prevalence of sternal foramen: quantitative, anatomical analysis and its clinical implications in acupuncture practice. Int J Morphol. 2012; 30(3): 1042–1049, doi: 10.4067/s0717-95022012000300045.
• 4. Babinski MA, de Lemos L, Babinski MSD, et al. Frequency of sternal foramen evaluated by MDCT: a minor variation of great relevance. Surg Radiol Anat. 2015; 37(3): 287–291, doi: 10.1007/s00276-014-1339-x, indexed in Pubmed: 25023390.
• 5. Bayaroğulları H, Yengil E, Davran R, et al. Evaluation of the postnatal development of the sternum and sternal variations using multidetector CT. Diagn Interv Radiol. 2014; 20(1): 82–89, doi: 10.5152/dir.2013.13121, indexed in Pubmed: 24100061.
• 6. Bermio VS, Jos Hemalatha GA. Congenital foramen in the body of sternum. Int J Anat Res. 2014; 2(3): 545–548.
• 7. Bhootra BL. Fatality following a sternal bone marrow aspiration procedure: a case report. Med Sci Law. 2004; 44(2): 170–172, doi: 10.1258/rsmmsl.44.2.170, indexed in Pubmed: 15176631.
• 8. Boruah DK, Prakash A, Yadav RR, et al. The safe zone for blinded sternal interventions based on CT evaluation of midline congenital sternal foramina. Skeletal Radiol. 2016; 45(12): 1619–1628, doi: 10.1007/s00256-016-2473-9, indexed in Pubmed: 27629288.
• 9. Cooper PD, Stewart JH, McCormick WF. Development and morphology of the sternal foramen. Am J Forensic Med Pathol. 1988; 9(4): 342–347, indexed in Pubmed: 3239556.
• 10. Cubuk S, Hamcan S. Anatomic variations of sternum may mimic traumatic complications. Am J Emerg Med. 2016; 34(9): 1912.e1–1912.e2, doi: 10.1016/j.ajem.2016.01.026, indexed in Pubmed: 26905807.
• 11. Duraikannu C, Noronha OV, Sundarrajan P. MDCT evaluation of sternal variations: Pictorial essay. Indian J Radiol Imaging. 2016; 26(2): 185–194, doi: 10.4103/0971-3026.184407, indexed in Pubmed: 27413263.
• 12. El-Busaid H, Kaisha W, Hassanali J, et al. Sternal foramina and variant xiphoid morphology in a Kenyan population. Folia Morphol. 2012; 71(1): 19–22, indexed in Pubmed: 22532180.
• 13. Fokin AA. Cleft sternum and sternal foramen. Chest Surg Clin N Am. 2000; 10(2): 261–276, indexed in Pubmed: 10803333.
• 14. Fokin AA. Thoracic defects: cleft sternum and Poland syndrome. Thorac Surg Clin. 2010; 20(4): 575–582, doi: 10.1016/j.thorsurg.2010.06.001, indexed in Pubmed: 20974442.
• 15. Gossner J. Relationship of sternal foramina to vital structures of the chest: a computed tomographic study. Anat Res Int. 2013; 2013: 780193, doi: 10.1155/2013/780193, indexed in Pubmed: 24224092.
• 16. Halvorsen TB, Anda SS, Naess AB, et al. Fatal cardiac tamponade after acupuncture through congenital sternal foramen. Lancet. 1995; 345(8958): 1175, indexed in Pubmed: 7723561.
• 17. Ishii S, Shishido F, Miyajima M, et al. Causes of photopenic defects in the lower sternum on bone scintigraphy and correlation with multidetector CT. Clin Nucl Med. 2011; 36(5): 355–358, doi: 10.1097/RLU.0b013e31820aa41b, indexed in Pubmed: 21467851.
• 18. Macaluso PJ, Lucena J. Morphological variations of the anterior thoracic skeleton and their forensic significance: radiographic findings in a Spanish autopsy sample. Forensic Sci Int. 2014; 241: 220.e1–220.e7, doi: 10.1016/j.forsciint.2014.05.009, indexed in Pubmed: 24933632.
• 19. McCormick WF. Sternal foramena in man. Am J Forensic Med Pathol. 1981; 2(3): 249–252, indexed in Pubmed: 7325136.
• 20. Moore MK, Stewart JH, McCormick WF. Anomalies of the human chest plate area. Radiographic findings in a large autopsy population. Am J Forensic Med Pathol. 1988; 9(4): 348–354, indexed in Pubmed: 3239557.
• 21. Paraskevas G, Tzika M, Anastasopoulos N, et al. Sternal foramina: incidence in Greek population, anatomy and clinical considerations. Surg Radiol Anat. 2015; 37(7): 845–851, doi: 10.1007/s00276-014-1412-5, indexed in Pubmed: 25552238.
• 22. Paraskevas GK, Tzika M, Natsis K. Double sternal foramina in a dried sternum: a rare normal variant and its radiologic assessment. Surg Radiol Anat. 2016; 38(8): 991–993, doi: 10.1007/s00276-016-1663-4, indexed in Pubmed: 26988088.
• 23. Pevenage P, De Maeseneer, M, Muylle K, et al. Sternal foramen simulating osteolytic lesion on scintigraphy and SPET imaging. Ann Nucl Med Sci. 2002; 15(4): 227–230.
• 24. Schratter M, Bijak M, Nissel H, et al. [The foramen sternale: a minor anomaly -- great relevance]. Rofo. 1997; 166(1): 69–71, doi: 10.1055/s-2007-1015380, indexed in Pubmed: 9072108.
• 25. Singh J, Pathak RK. Sex and age related non-metric variation of the human sternum in a Northwest Indian postmortem sample: a pilot study. Forensic Sci Int. 2013; 228(1-3): 181.e1–181.12, doi: 10.1016/j.forsciint.2013.02.002, indexed in Pubmed: 23453187.
• 26. Stark P. Midline sternal foramen: CT demonstration. J Comput Assist Tomogr. 1985; 9(3): 489–490, indexed in Pubmed: 3989043.
• 27. Uzun C, Atman ED, Ustuner E, et al. Surface anatomy and anatomical planes in the adult turkish population. Clin Anat. 2016; 29(2): 183–190, doi: 10.1002/ca.22634, indexed in Pubmed: 26403267.
• 28. Weaver AA, Schoell SL, Nguyen CM, et al. Morphometric analysis of variation in the sternum with sex and age. J Morphol. 2014; 275(11): 1284–1299, doi: 10.1002/jmor.20302, indexed in Pubmed: 24935890.
• 29. Xie YZ, Wang BJ, Yun JS, et al. Morphology of the human xiphoid process: dissection and radiography of cadavers and MDCT of patients. Surg Radiol Anat. 2014; 36(3): 209–217, doi: 10.1007/s00276-013-1163-8, indexed in Pubmed: 23839070.
• 30. Yekeler E, Tunaci M, Tunaci A, et al. Frequency of sternal variations and anomalies evaluated by MDCT. AJR Am J Roentgenol. 2006; 186(4): 956–960, doi: 10.2214/AJR.04.1779, indexed in Pubmed: 16554563.

Identyfikatory

DOI

10.5603/FM.a2017.0006