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

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 (11.6×106/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. …