Sternum AP & LAT View at Dr. Essa Lab

Sternum AP & LAT View at Dr. Essa Lab

The sternum, commonly referred to as the breastbone, is a flat, T-shaped bone situated anteriorly in the middle of the thoracic wall. It serves as a critical anatomical shield, protecting vital mediastinal organs including the heart, the ascending aorta, the trachea, and the esophagus. A Sternum AP & LAT View at Dr. Essa Lab is a highly specialized radiographic examination designed to visualize this bone in two perpendicular planes. Unlike a standard chest X-ray, which is optimized to evaluate the lung parenchyma and cardiac silhouette, a dedicated sternal series utilizes precise radiographic techniques to isolate the sternum from the overlying thoracic spine and dense mediastinal structures. At Dr. Essa Lab, we utilize state-of-the-art digital radiography (DR) systems that deliver exceptional spatial resolution, allowing our consultant radiologists to detect subtle fractures, joint subluxations, and bone pathologies while keeping patient radiation exposure to an absolute minimum.

The diagnostic value of a Sternum AP & LAT View lies in its ability to provide a clear, unobstructed profile of the sternal anatomy. The examination consists of two primary views: the Anteroposterior (AP) or Posteroanterior (PA) view, and the Lateral (LAT) view. In practice, the AP projection is often performed with a slight oblique angle (typically the Right Anterior Oblique or RAO position) to project the sternum away from the dense shadow of the thoracic spine and over the homogenous density of the heart. Additionally, a specialized breathing technique is frequently employed during the AP exposure, where the patient takes shallow breaths to blur out the overlying pulmonary vasculature, leaving the sternum in sharp focus. The Lateral view provides a true profile perspective, which is indispensable for evaluating the alignment of the three sternal segments—the manubrium, the body (gladiolus), and the xiphoid process—and for assessing the retrosternal space for any soft tissue swelling or fluid collections.

This imaging modality is highly beneficial due to its rapid acquisition time, cost-effectiveness, and immediate diagnostic utility. It is the primary imaging choice for patients presenting with acute anterior chest wall trauma, suspected post-surgical complications following a median sternotomy, or localized bone pain. By choosing Dr. Essa Lab, patients benefit from a legacy of diagnostic excellence, advanced imaging technology, and professional interpretations by experienced radiologists across our extensive network of centers in Karachi and beyond.

Clinical Procedure: What to Expect

Patient Preparation

Preparing for a Sternum AP & LAT View is straightforward, as it is a non-invasive, plain radiographic procedure that does not require contrast media or fasting. However, adhering to the following guidelines ensures optimal image quality and patient safety:

• Remove Metallic Objects: Patients must remove all metal items from the chest and neck area, including necklaces, body piercings, and clothing with metallic zippers, buttons, or underwires, as these can create dense artifacts on the X-ray image.
• Wear Appropriate Attire: You will be provided with a clean, comfortable hospital gown to wear during the procedure to prevent any fabric-related artifacts.
• Screening for Pregnancy: Female patients of childbearing age must inform the radiographer if there is any possibility of pregnancy. Although the radiation dose is minimal, protective lead shielding will be used, or alternative non-ionizing imaging modalities may be discussed with the referring physician.
• No Fasting Required: There are no dietary restrictions; you may eat, drink, and take your regular medications as prescribed.
• Bring Previous Records: If you have had prior sternal imaging or thoracic surgeries, bringing those reports and films can be highly beneficial for comparative analysis.

During the Procedure

The procedure is conducted by a certified radiologic technologist and typically takes between 10 to 15 minutes. Here is what you can expect during the imaging session:

• Positioning for the AP/Oblique View: You will be asked to stand or lie prone against the digital image receptor. The technologist will gently rotate your body slightly (approximately 15 to 20 degrees) into an oblique position. This specific angulation projects the sternum to the side of the spine, utilizing the heart shadow as a uniform background to enhance contrast.
• Breathing Instructions for the AP View: The technologist may instruct you to take shallow, gentle breaths during a slightly longer exposure time. This technique blurs the ribs and lung markings, leaving the sternum clearly visible. Alternatively, you may be asked to hold your breath after expiration.
• Positioning for the Lateral View: For the profile view, you will stand sideways against the image receptor. You will be asked to clasp your hands behind your back, pull your shoulders back, and puff your chest forward. This positioning projects the sternum anteriorly, free from overlying soft tissues and humeral shadows.
• Breathing Instructions for the Lateral View: You will be instructed to take a deep breath in and hold it. This expands the lungs, filling the retrosternal space with air, which provides an excellent contrasting background for the posterior border of the sternum.
• Safety and Comfort: The technologist will step behind a protective lead barrier to activate the X-ray machine. The procedure is entirely painless, and you will only hear the click of the machine. Lead aprons or thyroid shields may be provided to protect non-targeted body regions from scatter radiation.

When is a Sternum AP & LAT View Performed?

Sternal Fracture and Trauma

Sternal fractures are most commonly caused by high-impact blunt force trauma to the anterior chest wall, such as steering wheel impacts during motor vehicle collisions, sports injuries, or severe falls. Patients typically present with intense, localized chest pain that worsens with deep inspiration, coughing, or physical movement. A Sternum AP & LAT View is rapidly performed in emergency settings to identify cortical disruptions, assess the degree of fracture displacement, and evaluate for potential retrosternal hematomas that could compress mediastinal structures.

Post-Surgical Evaluation (Sternotomy)

A median sternotomy is the standard surgical incision used to access the thoracic cavity for major cardiac procedures, such as coronary artery bypass grafting (CABG) or heart valve replacements. Following surgery, the sternum is closed and stabilized using heavy surgical wires. If a patient experiences post-operative chest wall instability, a clicking or grinding sensation, or signs of wound infection, a Sternum AP & LAT View is indicated to evaluate the integrity of the sternal wires, detect wire breakage or migration, and assess for sternal dehiscence (separation of the sternal halves).

Sternal Osteomyelitis or Infection

Osteomyelitis of the sternum is a serious bone infection that can occur as a complication of median sternotomy or, less frequently, from hematogenous spread or direct extension of deep tissue infections. Patients often present with persistent chest pain, localized redness, warmth, swelling, and purulent discharge from the surgical site. The AP and Lateral radiographic views assist in detecting early signs of bone destruction, periosteal reaction, or retrosternal soft tissue swelling, which are critical for guiding aggressive antibiotic therapy or surgical debridement.

Unexplained Anterior Chest Wall Pain

Anterior chest wall pain can arise from various musculoskeletal conditions that mimic cardiac or pulmonary emergencies. Once life-threatening cardiovascular causes have been ruled out via electrocardiograms and blood tests, a Sternum AP & LAT View is performed to investigate localized pathologies. This includes evaluating the manubriosternal or sternoclavicular joints for inflammatory arthropathies, osteoarthritis, or costochondritis, helping clinicians establish an accurate diagnosis and initiate appropriate pain management.

Sternal Neoplasms or Metastatic Disease

While primary bone tumors of the sternum (such as chondrosarcomas or osteosarcomas) are relatively rare, the sternum is a common site for metastatic disease originating from primary malignancies of the breast, lung, prostate, or kidneys, as well as hematological malignancies like multiple myeloma. Patients may present with localized, dull bone pain or a palpable chest wall mass. The AP and Lateral views allow radiologists to detect osteolytic (bone-destroying) or osteoblastic (bone-forming) lesions, cortical thinning, and pathological fractures.

What Does a Sternum AP & LAT View Detect?

A detailed radiographic evaluation of the sternum can identify a wide range of traumatic, post-surgical, inflammatory, and neoplastic conditions. The primary clinical findings detectable on a Sternum AP & LAT View include:

• Transverse sternal fractures, most commonly occurring at the junction of the manubrium and the sternal body.
• Oblique or longitudinal fractures of the sternal body.
• Displaced or angulated fracture fragments that may impinge on mediastinal structures.
• Sternal wire breakage or fragmentation in post-coronary artery bypass graft (CABG) patients.
• Sternal wire migration or cutting through the sternal bone (wire pull-out).
• Sternal dehiscence, characterized by a visible gap or separation between the lateral halves of a surgically divided sternum.
• Osteolytic bone destruction, indicating metastatic disease, multiple myeloma, or primary bone tumors.
• Osteoblastic or sclerotic lesions, which may represent healing bone or osteoblastic metastases.
• Sternal osteomyelitis, characterized by irregular bone erosion, cortical loss, and periosteal reaction.
• Retrosternal soft tissue swelling or fluid collection, suggestive of a retrosternal hematoma or abscess.
• Subcutaneous emphysema, indicating air trapping in the soft tissues of the chest wall, often associated with pneumomediastinum or pneumothorax.
• Sternoclavicular joint subluxation or dislocation, visible on the AP/oblique views.
• Sternoclavicular joint osteoarthritis, characterized by joint space narrowing, subchondral sclerosis, and osteophyte formation.
• Manubriosternal joint subluxation, dislocation, or inflammatory erosion (often associated with ankylosing spondylitis).
• Pectus excavatum (funnel chest), a congenital chest wall deformity visible as posterior depression of the sternum on the lateral view.
• Pectus carinatum (pigeon chest), a congenital deformity characterized by anterior protrusion of the sternum.
• Sternal cleft or bifid sternum, a rare congenital anomaly resulting from incomplete fusion of the sternal bars.
• Sternal foramen, a common benign anatomical variant representing an incomplete midline fusion hole, which must not be confused with a lytic lesion.
• Callus formation, indicating a healing sternal fracture.
• Xiphoid process fracture or painful deviation, often caused by direct localized trauma.
• Retrosternal air (pneumomediastinum), visible as a lucent line behind the sternum on the lateral projection.
• Osteopenia or localized osteoporosis of the sternal segments.
• Sternal erosion caused by adjacent aortic aneurysms (rare but clinically significant).
• Soft tissue calcifications or foreign bodies in the anterior chest wall.

Turnaround Time and Report Access at Dr. Essa Lab

At Dr. Essa Lab, we understand that timely diagnostic results are crucial for effective clinical decision-making and patient peace of mind. Once your Sternum AP & LAT View is completed, the digital radiographic images are immediately uploaded to our secure Picture Archiving and Communication System (PACS). Our team of highly qualified consultant radiologists, who possess specialized expertise in musculoskeletal and thoracic imaging, will meticulously review the images and compile a comprehensive diagnostic report.

The finalized report and high-quality digital images are typically available within a few hours of the procedure. Dr. Essa Lab offers multiple convenient ways to access your results. Patients can securely download their reports and view their X-ray images online through the official Dr. Essa Lab patient portal or our dedicated mobile application. Additionally, physical copies of the report and high-resolution films can be collected directly from the diagnostic center where the scan was performed. An automated SMS notification will be sent to your registered mobile number as soon as your report is ready.

Sternum AP & LAT View Findings Overview

Structure / Parameter Evaluated	Normal Findings	Possible Abnormal Findings
Manubrium	Intact cortex, normal bone density, smooth margins.	Transverse fracture, osteolytic destruction, erosion from adjacent masses.
Sternal Body (Gladiolus)	Continuous cortical bone, uniform trabecular pattern, straight alignment.	Displaced or non-displaced fractures, osteomyelitis, metastatic lesions.
Xiphoid Process	Normal variable ossification, aligned with the sternal body.	Fracture, painful anterior/posterior displacement, calcified spurs.
Sternoclavicular Joints	Symmetric joint spaces, intact articular surfaces.	Subluxation, dislocation, osteophytic narrowing, erosive arthritis.
Manubriosternal Joint	Narrow, well-defined joint space, intact margins.	Diastasis, subluxation, inflammatory erosion, ankylosis.
Retrosternal Space	Clear, air-filled pulmonary lucency behind the sternum.	Soft tissue density (hematoma/abscess), free air (pneumomediastinum).
Sternal Wires (Post-Op)	Intact, symmetrically aligned, securing the sternal halves.	Broken wires, displaced wires, wire migration through bone, dehiscence.
Anterior Soft Tissues	Normal thickness, no abnormal density or gas shadows.	Swelling, subcutaneous emphysema, abscess, foreign bodies.

Note: Diagnostic findings should always be interpreted by a qualified healthcare professional together with the patient’s symptoms, medical history, physical examination, laboratory investigations, previous imaging studies, and other relevant clinical information. Additional investigations or specialist consultation may be recommended depending on the findings.

Why Choose Dr. Essa Lab for Sternum AP & LAT View?

• Experienced Healthcare Professionals: Our team consists of highly qualified radiologic technologists and consultant radiologists with decades of collective experience in thoracic and musculoskeletal imaging.
• Patient-Focused Care: We prioritize patient comfort, safety, and dignity, ensuring a supportive and compassionate environment throughout your diagnostic journey.
• Quality Diagnostic Services: Dr. Essa Lab is committed to clinical excellence, utilizing stringent quality control measures to deliver highly accurate and reliable diagnostic reports.
• Modern Diagnostic Approach: We utilize advanced digital radiography (DR) systems that maximize image clarity while minimizing radiation exposure.
• Convenient Location: With an extensive network of branches across Karachi and other major cities, accessing quality diagnostic imaging has never been easier.
• Rapid Turnaround Time: We ensure that your reports are processed, reviewed, and finalized promptly to facilitate timely medical intervention.
• Easy Online Report Access: Patients can view, download, and share their reports and digital images anytime via our secure online portal and mobile app.
• Legacy of Trust: Established in 1987 by Prof. Dr. M. Essa Abdulla, Dr. Essa Lab is one of Pakistan’s most trusted diagnostic chains, recognized for its commitment to affordable, high-quality healthcare.