Article metrics

  • citations in SCindeks: 0
  • citations in CrossRef:0
  • citations in Google Scholar:[=>]
  • visits in previous 30 days:5
  • full-text downloads in 30 days:0
article: 9 from 324  
Back back to result list
Vojnosanitetski pregled
2019, vol. 76, iss. 2, pp. 186-191
article language: English
document type: Original Scientific Paper
published on: 25/04/2019
doi: 10.2298/VSP170321084V
Creative Commons License 4.0
Multidetector computed tomography (MDCT) estimation of prevalence and anatomic characteristics of the sternal body foramen in the population of central Serbia
aUniversity of Kragujevac, Faculty of Medicine, Department of Anatomy and Forensic Medicine + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade
bUniversity of Kragujevac, Faculty of Medicine, Department of Hygiene and ecology
cMilitary Medical Academy, Clinic for Orthopedic Surgery and Traumatology, Belgrade
dUniversity of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade
eUniversity of Kragujevac, Faculty of Medicine, Department of Surgery
fUniversity Clinical Centre of the Republic of Srpska, Clinic of General and Abdominal Surgery, Banja Luka, Republic of Srpska, B&H
gAmbulance Brigade of Guards, Belgrade
hUniversity of Kragujevac, Faculty of Medicine



Background/Aim. The most frequent form of sternal defects is a single foramen, usually located at the distal half of the sternal body, with prevalence that varies among different ethnic populations. Clinical importance of these defects arises from various diagnostic and therapeutic sternal treatments and close location of heart, lungs and other vital organs of the chest cavity. The aim of this study was to determine the prevalence and morphometric characteristics of the sternal midline foramen in the population of central Serbia. Methods. The multidetector computed tomography (MDCT) chest images of 422 patients of both genders were analyzed. The radiological imaging was performed on 64- slice MDCT scanner (Aquilion 64, Toshiba, Japan). All scans were performed in the axial plane, with subsequent multiplanar reconstruction (MPR). Due to the angulation of the sternal body coronal curved-planar, the images were obtained in order to show the whole length of the sternum and the vertical diameter of the sternal foramen. The measurements were done using the commercially available software (Imaging Software ver., Vital-Images). Results. The solitary foramen, located in the distal segment of the sternal body, was detected in 24 patients, representing 5.9% of the observed population with slightly higher prevalence in males. The average size of foramen was 3.9 × 4.2 mm. The mean distance from the skin was 12.7 ± 3.3 mm, the distance from skin to pericardium was on average 37.3 ± 8.2 mm, while the average distance from skin to pleura was 25 ± 5.9 mm. The average depth of foramen 8.7 ± 2 mm, while the mean distance from the posterior surface of foramen to pericardium was 12.7 ± 9.1 mm. Conclusion. The results presented in this paper confirmed the prevalence of 5.9% regarding the midline sternal foramen in the observed population. Serious complications of the sternal puncture could be prevented by prior MDCT imaging.



Aktan, Z.A., Savaş, R. (1998) Anatomic and HRCT Demonstration of Midline Sternal Foramina. Tr J Med Sci, 28: 511-4
Babinski, M.A., Rafael, F.A., Steil, A.D., Sousa-Rodrigues, C.F., Sgrott, E.A., de Paula, R.C., Fernandes, R.M. P. (2012) High Prevalence of Sternal Foramen: Quantitative, Anatomical Analysis and its Clinical Implications in Acupuncture Practice. International Journal of Morphology, 30(3): 1042-1049
Babinski, M.A., de Lemos, L., Babinski, M.S. D., Gonçalves, M.V. T., de Paula, R.C., Fernandes, R.M. P. (2015) Frequency of sternal foramen evaluated by MDCT: a minor variation of great relevance. Surgical and Radiologic Anatomy, 37(3): 287-291
Bayaroğulları, H., Yengil, E., Davran, R., Ağlagül, E., Karazincir, S., Balcı, A. (2014) Evaluation of the postnatal development of the sternum and sternal variations using multidetector CT. Diagn Interv Radiol, 20(1): 82-9
Bermio, V.S., Jos, H.G.A. (2014) Congenital foramen in the body of sternum. Int J Anat Res, 2(3): 545-8
Bhootra, B.L. (2004) Fatality Following a Sternal Bone Marrow Aspiration Procedure. Medicine, Science and the Law, 44(2): 170-172
Cooper, P.D., Stewart, J.H., McCormick, W.F. (1988) Development and Morphology of the Sternal Foramen. American Journal of Forensic Medicine and Pathology, 9(4): 342-347
El-Busaid, H., Kaisha, W., Hassanali, J., Hassan, S., Ogengo, J., Mandela, P. (2012) Sternal foramina and variant xiphoid morphology in a Kenyan population. Folia Morphol (Warsz), 71(1): 19-22
Fujita, H., Tomiyama, J., Nishimura, S. (2012) High Contact Pressure Resulting from Bone Marrow Puncture. Open Journal of Blood Diseases, 02(03): 56-58
Gossner, J. (2013) Relationship of Sternal Foramina to Vital Structures of the Chest: A Computed Tomographic Study. Anatomy Research International, 2013: 1-4
Gossner, J. (2014) A case of an incomplete sternal foramen. Int J Anat Var (IJAV), 7: 89-90
Halvorsen, T.B., Anda, S.S., Naess, A.B., Levang, O.W. (1995) Fatal cardiac tamponade after acupuncture through congenital sternal foramen. Lancet, 345(8958): 1175
Han, D.H., Ahn, M.I., Jung, J.I., Park, S.H. (2009) An asymptomatic young woman with abnormal manubrium sterni: diagnosis and discussion. Skeletal Radiology, 38(10): 1027-1027
Ishii, S., Shishido, F., Miyajima, M., Sakuma, K., Shigihara, T., Kikuchi, K., Nakajima, M. (2011) Causes of Photopenic Defects in the Lower Sternum on Bone Scintigraphy and Correlation With Multidetector CT. Clinical Nuclear Medicine, 36(5): 355-358
Jakhar, J.K., Dagar, T., Dhattarwal, S.K., Pal, V. (2015) The Sternal Foramen: The Possible Forensic Misinterpretation of an Anatomic Abnormality. Journal of Indian Academy of Forensic Medicine, 37(3): 315
Johnson, D., Shah, P., Collins, P., Wigley, C., In, T., Stranding, S., ur. (2008) Gray's anatomy: The anatomical basis of clinical practice. Edinburgh: Elsevier Churchill Livingstone, p. 952-9; 39th ed
Kumarasamy, S.A., Agrawal, R. (2011) A large sternal foramen. Int J Anat Var (IJAV), 4: 195-6
Macaluso, P. J., Lucena, J. (2014) Morphological variations of the anterior thoracic skeleton and their forensic significance: Radiographic findings in a Spanish autopsy sample. Forensic Science International, 241: 220.e1-220.e7
Moore, K.L., Persaud, T.V.N. (2008) The developing human: Clinically oriented embryology. Philadelphia, itd: W.B. Saunders
Ogengo, J. (2013) Clinical significance of anatomical variations. Anat J Afr, 2(1): 57-60
Paraskevas, G., Tzika, M., Anastasopoulos, N., Kitsoulis, P., Sofidis, G., Natsis, K. (2015) Sternal foramina: incidence in Greek population, anatomy and clinical considerations. Surgical and Radiologic Anatomy, 37(7): 845-851
Paraskevas, G.K., Tzika, M., Natsis, K. (2016) Double sternal foramina in a dried sternum: a rare normal variant and its radiologic assessment. Surgical and Radiologic Anatomy, 38(8): 991-993
Pevenage, P., de Maeseneer, M., Muylle, K., Osteaux, M. (2002) Sternal foramen simulating osteolytic lesion on scintigraphy and SPET imaging. Ann Nucl Med Sci, 15(4): 227-9
Saccheri, P., Sabbadini, G., Toso, F., Travan, L. (2012) A keyhole-shaped sternal defect in an ancient human skeleton. Surgical and Radiologic Anatomy, 34(10): 965-968
Sañudo, J.R., Vázquez, R., Puerta, P. (2003) Meaning and clinical interest of the anatomical variations in the 21st century. Eur J Anat, 7(Suppl 1): 1-3
Schratter, M., Bijak, M., Nissel, H., Gruber, I., Schratter-Sehn, A. (1997) Foramen sternale: Kleine Anomalie - große Relevanz. RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 166(01): 69-71
Singh, J., Pathak, R.K. (2013) Sex and age related non-metric variation of the human sternum in a Northwest Indian postmortem sample: A pilot study. Forensic Science International, 228(1-3): 181.e1-181.e12
Tuncer, C.M., Aluçlu, U.M., Karabulut, O., Ulkü, R., Hatipoğlu, S.E., Nazaroğlu, H. (2009) The demonstration of the inferior sternal cleft using three-dimensional reconstruction: a case report. Rom J Morphol Embryol, 50(3): 513-6
van Marum, R. (2001) Cardiac tamponade following sternal puncture in two patients. Netherlands Journal of Medicine, 59(1): 39-40
Wolochow, M.S. (1995) Fatal cardiac tamponade through congenital sternal foramen. Lancet, 346(8972): 442
Yekeler, E., Tunaci, M., Tunaci, A., Dursun, M., Acunas, G. (2006) Frequency of Sternal Variations and Anomalies Evaluated by MDCT. American Journal of Roentgenology, 186(4): 956-960