Computed tomography of the sternum and its articulations

The chest wall presents diagnostic difficulties for both the clinician and the radiologist. Because of normal variations in anatomy and ossification, analysis of the sternal region can be particularly confusing. We reviewed the normal computed tomographic (CT) appearance of the sternum in 354 patients. Important normal sternal variants included cortical unsharpness along the posterior aspect of the manubrium, lateral surfaces of the body, and at the sternal fibrocartilaginous articulations; soft tissue prominence at the junction of the sternum and costochondral cartilage; and bony sclerosis at the transitions from manubrium to body and from body to xiphoid. In seven patients with clinically significant sternal abnormality, key CT features were abnormal soft tissue mass (7/7), destruction or irregularity of the cortical contour (7/7), and abnormal increased attenuation of bone (1/7). CT should be the radiologic study of choice in patients with suspected abnormality of the sternum and its articulations.