Sternal nonunion and sternal dehiscence may be characterized at CT, with sternal gap >3 mm correlating with significantly higher chest pain intensity compared with those with minor dehiscence and those with normal sternal healing, as determined by chest CT [8,64,70]. Chest CT with 3-D reconstructions was useful in assessing the degree of healing and residual chest wall deformities in 46 patients randomized to either operative or nonoperative management of flail chest [71]. CT is commonly used in the pre- and postoperative evaluation of patients who underwent chest wall reconstruction for rib fractures and chest wall tumors [72,73]. Rarely, desmoid-type fibromatosis can occur at prior thoracotomy sites Nontraumatic Chest Wall Pain and may mimic chest wall recurrence. CT in combination with FDG-PET/CT is useful for detecting and characterizing these lesions and for image-guided biopsy [74]. FDG-PET/CT Skull Base to Mid-Thigh Investigators have shown a positive dose-dependent relationship in chest wall FDG-PET/CT uptake predictive of patients who later developed chest wall complications (pain and rib fractures) after stereotactic body radiation therapy for lung cancer [75]. False-positive diagnoses can occur in cases in which there is myositis-related FDG uptake in the chest wall musculature in patients who have undergone prior radiation [76]. Furthermore, FDG- PET/CT is valuable in determining depth of infection, involvement of costal cartilages, and for preoperative planning of debridement procedures in patients with deep sternal wound infections after sternotomy procedures [77]. The sensitivity and specificity of FDG-PET/CT for sternal wound infections was 91% and 97%, respectively, with SUVmax showing value in patients who are imaged >6 months after surgery [78].
Nontraumatic Chest Wall Pain. Sternal nonunion and sternal dehiscence may be characterized at CT, with sternal gap >3 mm correlating with significantly higher chest pain intensity compared with those with minor dehiscence and those with normal sternal healing, as determined by chest CT [8,64,70]. Chest CT with 3-D reconstructions was useful in assessing the degree of healing and residual chest wall deformities in 46 patients randomized to either operative or nonoperative management of flail chest [71]. CT is commonly used in the pre- and postoperative evaluation of patients who underwent chest wall reconstruction for rib fractures and chest wall tumors [72,73]. Rarely, desmoid-type fibromatosis can occur at prior thoracotomy sites Nontraumatic Chest Wall Pain and may mimic chest wall recurrence. CT in combination with FDG-PET/CT is useful for detecting and characterizing these lesions and for image-guided biopsy [74]. FDG-PET/CT Skull Base to Mid-Thigh Investigators have shown a positive dose-dependent relationship in chest wall FDG-PET/CT uptake predictive of patients who later developed chest wall complications (pain and rib fractures) after stereotactic body radiation therapy for lung cancer [75]. False-positive diagnoses can occur in cases in which there is myositis-related FDG uptake in the chest wall musculature in patients who have undergone prior radiation [76]. Furthermore, FDG- PET/CT is valuable in determining depth of infection, involvement of costal cartilages, and for preoperative planning of debridement procedures in patients with deep sternal wound infections after sternotomy procedures [77]. The sensitivity and specificity of FDG-PET/CT for sternal wound infections was 91% and 97%, respectively, with SUVmax showing value in patients who are imaged >6 months after surgery [78].