Sternum AP & LAT View (DC) at Dr. Essa Lab

Introduction to Sternum AP & LAT View (DC) at Dr. Essa Lab

The Sternum AP & LAT View (DC) at Dr. Essa Lab is a specialized digital radiography examination designed to evaluate the sternum, commonly known as the breastbone. The sternum is a flat, T-shaped bone located in the center of the anterior chest wall. It plays a critical role in protecting vital thoracic organs, including the heart, lungs, and major blood vessels, while serving as an anchor point for the ribs and clavicles. Utilizing advanced Digital Capture (DC) technology, this imaging study provides high-resolution, high-contrast radiographic images that allow consultant radiologists and clinicians to detect fractures, joint dislocations, inflammatory conditions, post-surgical complications, and bone lesions with exceptional precision.

Standard chest X-rays often fail to visualize the sternum adequately due to the superimposition of the thoracic spine and mediastinal structures. Therefore, a dedicated sternum series consisting of Anteroposterior (AP) or Right Anterior Oblique (RAO) and Lateral (LAT) views is clinically necessary. The oblique projection projects the sternum away from the dense shadow of the spine and into the homogenous shadow of the heart, while the lateral view provides a clear profile of the bone, allowing for the assessment of displacement, retrosternal space, and cortical continuity. Dr. Essa Lab, a pioneer in diagnostic imaging in Pakistan, utilizes state-of-the-art digital radiography systems to perform this examination, ensuring minimal radiation exposure and rapid, highly accurate diagnostic reporting.

Clinical Procedure: What to Expect

Patient Preparation

Preparing for a Sternum AP & LAT View (DC) is straightforward and requires minimal effort from the patient. However, adhering to the following guidelines ensures optimal image quality and patient safety:

• Clothing and Accessories: Patients are advised to wear loose, comfortable clothing. Before the procedure, you will be asked to remove all metallic objects from the chest area, including necklaces, body piercings, bras with metal underwires, and clothing with metallic buttons or zippers, as metal creates artifacts that can obscure bone details.
• Pregnancy Notification: Female patients must inform the technologist if there is any possibility of pregnancy. Although the radiation dose is extremely low, appropriate pelvic shielding will be provided, or alternative imaging may be considered to protect the developing fetus.
• Medical History: If you have had recent cardiothoracic surgery (such as a coronary artery bypass graft) or have surgical wires in your chest, please inform the technologist beforehand.
• Fasting: No fasting or dietary restrictions are required for this plain digital X-ray. You may eat, drink, and take your routine medications as usual.

During the Procedure

The Sternum AP & LAT View (DC) is a quick, non-invasive, and painless procedure performed by a registered radiologic technologist. The entire process typically takes between 10 to 15 minutes. Here is what you can expect during the examination:

• Positioning for the AP/Oblique View: To obtain a clear front-facing view without spinal superimposition, the technologist will position you against the digital detector. You may be asked to rotate your body slightly (usually into a Right Anterior Oblique position) and press your chest against the imaging plate. This angle allows the sternum to be projected clearly over the heart shadow.
• Positioning for the Lateral View: For the lateral projection, you will stand or lie on your side. You will be instructed to draw your arms back and chest forward. This pulls the shoulders away from the sternum, providing an unobstructed profile view of the breastbone.
• Breathing Instructions: The technologist will instruct you to take a deep breath and hold it, or to breathe gently during a longer exposure (using a breathing technique to blur out overlying lung markings). Remaining completely still is crucial to prevent motion blur.
• Radiation Safety: Lead aprons or shields may be placed over your pelvic region to protect reproductive organs from scattered radiation. The digital capture technology used at Dr. Essa Lab automatically optimizes the radiation dose, keeping it as low as reasonably achievable (ALARA) while maintaining superior image quality.

When is a Sternum AP & LAT View (DC) Performed?

Evaluation of Blunt Chest Trauma and Suspected Fractures

Physicians frequently request a sternum X-ray following direct trauma to the anterior chest wall, such as steering wheel impacts during motor vehicle accidents, sports injuries, or severe falls. Sternal fractures can be highly painful and may be accompanied by underlying myocardial or pulmonary contusions. The lateral view is particularly valuable in these scenarios, as it easily demonstrates transverse fractures and any posterior displacement of bone fragments that could potentially impinge on the heart or great vessels.

Post-Operative Monitoring of Sternal Healing (Post-Sternotomy)

Patients who have undergone open-heart surgery or other cardiothoracic procedures require a median sternotomy, where the sternum is surgically split and later rejoined using stainless steel wires. A Sternum AP & LAT View (DC) is performed post-operatively to monitor bone healing, assess the alignment of the sternal halves, and ensure that the surgical wires remain intact, secure, and free from displacement or breakage.

Investigation of Unexplained Localized Chest Wall Pain

Persistent, localized pain over the breastbone that is tender to the touch warrants diagnostic imaging. While costochondritis (inflammation of the cartilage connecting the ribs to the sternum) is a common clinical diagnosis, an X-ray is essential to rule out other underlying bony pathologies, such as stress fractures, osteolytic lesions, or chronic inflammatory joint diseases affecting the sternoclavicular or manubriosternal joints.

Assessment of Sternoclavicular and Sternocostal Joint Disorders

The sternoclavicular (SC) joints connect the collarbones to the upper part of the sternum (manubrium). Disorders such as osteoarthritis, rheumatoid arthritis, septic arthritis, or traumatic dislocations of the SC joints can cause severe pain and restricted shoulder movement. The AP and oblique views help visualize these joint spaces, allowing radiologists to identify joint space narrowing, subchondral sclerosis, or subluxations.

Evaluation of Sternal Deformities and Congenital Anomalies

Congenital chest wall deformities, such as pectus excavatum (sunken chest) and pectus carinatum (pigeon chest), alter the anatomical position and shape of the sternum. A lateral digital X-ray provides an excellent profile view to assess the severity of the sternal depression or protrusion, helping thoracic surgeons plan corrective interventions and monitor structural changes over time.

What Does a Sternum AP & LAT View (DC) Detect?

A Sternum AP & LAT View (DC) is highly sensitive in detecting a wide range of structural, traumatic, inflammatory, and neoplastic conditions affecting the anterior chest wall. Specific findings include:

• Transverse Sternal Fractures: Breaks running horizontally across the sternal body, most commonly occurring near the manubriosternal joint.
• Sternal Displacement: Anterior or posterior shifting of fractured bone fragments, critical for assessing the risk of internal thoracic organ injury.
• Sternal Wire Breakage: Fractured or snapped stainless steel wires in patients with a history of median sternotomy.
• Sternal Wire Displacement: Migration or loosening of surgical wires, which can lead to sternal instability or dehiscence.
• Sternal Dehiscence: Separation of the two halves of a surgically split sternum, a serious post-operative complication.
• Manubriosternal Joint Subluxation: Dislocation or partial misalignment at the junction between the manubrium and the sternal body.
• Osteomyelitis of the Sternum: Bone infection characterized by localized bone destruction (lysis) and periosteal reaction, often seen post-surgery.
• Osteolytic Lesions: Areas of localized bone destruction, which may indicate primary bone tumors, multiple myeloma, or metastatic disease.
• Osteoblastic Lesions: Areas of abnormal bone density or hardening, often associated with metastatic prostate or breast cancer.
• Sternoclavicular Joint Dislocation: Displacement of the clavicle head from its articulation with the manubrium.
• Sternoclavicular Osteoarthritis: Degenerative joint changes including joint space narrowing, osteophyte formation, and subchondral sclerosis.
• Pectus Excavatum: Posterior depression of the lower sternum, clearly visible on the lateral projection.
• Pectus Carinatum: Anterior protrusion of the sternum and costal cartilages.
• Sternal Cleft: A rare congenital anomaly where the sternum fails to fuse completely during embryonic development.
• Xiphoid Process Fracture: Trauma-induced fracture of the small, cartilaginous/bony tip at the bottom of the sternum.
• Sternal Osteopenia: Generalized reduction in bone mineral density, predisposing the patient to insufficiency fractures.
• Retrosternal Soft Tissue Mass: Soft tissue density behind the sternum, indicating potential substernal thyroid, thymoma, or lymphadenopathy.
• Subcutaneous Emphysema: Air trapped in the soft tissues overlying the sternum, often secondary to a pneumothorax or tracheal injury.
• Sternal Sclerosis: Abnormal thickening of the bone, which can occur in chronic inflammatory conditions like SAPHO syndrome.
• Sternal Erosion: Wearing away of the sternal bone, which can be caused by chronic pressure from an adjacent aortic aneurysm or large mediastinal mass.

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. Our digital radiography (DC) workflow is optimized for speed and accuracy. Once your Sternum AP & LAT View (DC) is completed, the high-resolution digital images are immediately transmitted via our secure Picture Archiving and Communication System (PACS) to our team of board-certified consultant radiologists.

The formal diagnostic report is typically compiled and verified within a few hours of the procedure. Patients can conveniently access their reports and digital images online through the Dr. Essa Lab patient portal or mobile application. Physical copies of the report, along with high-quality laser-printed X-ray films or digital CDs, can also be collected directly from the diagnostic center where the test was performed. Our staff is always available to assist you with any queries regarding report collection.

Sternum AP & LAT View (DC) Findings Overview

The following table outlines the key anatomical structures evaluated during a Sternum AP & LAT View (DC) examination, along with typical normal and abnormal findings:

Structure / Parameter Evaluated	Normal Findings	Possible Abnormal Findings
Sternal Body & Manubrium	Intact cortex, uniform bone density, and normal trabecular pattern. No evidence of lucency or sclerosis.	Transverse or oblique fractures, osteolytic or osteoblastic lesions, bone destruction, or localized sclerosis.
Sternal Alignment	Smooth, continuous anterior and posterior cortical margins on the lateral view.	Anterior or posterior displacement of bone fragments, sternal dehiscence, or step-off deformities.
Sternoclavicular (SC) Joints	Symmetric joint spaces with well-aligned clavicular heads articulating with the manubrium.	Joint space narrowing, subchondral sclerosis, osteophytes, or anterior/posterior dislocation.
Sternal Wires (Post-CABG)	Intact, symmetrically aligned, and tightly twisted stainless steel wires securing the sternum (if applicable).	Broken wires, displaced or migrated wires, or widening of the surgical cleft (dehiscence).
Retrosternal Space	Clear, normal radiolucency behind the sternum without abnormal soft tissue density.	Retrosternal soft tissue mass, hematoma, or displacement of mediastinal structures.
Xiphoid Process	Normal anatomical position and density appropriate for the patient’s age (may be partially cartilaginous).	Fracture, deviation, or osteolytic destruction.
Surrounding Soft Tissue	Normal soft tissue thickness and density without swelling or foreign bodies.	Subcutaneous emphysema (air in tissues), localized swelling, hematoma, or metallic 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 (DC)?

• Pioneering Diagnostic Excellence: Established in 1987, Dr. Essa Lab is one of Pakistan’s most trusted and recognized names in diagnostic medicine.
• Advanced Digital Radiography (DC): We utilize cutting-edge digital capture technology that delivers superior image resolution with significantly lower radiation exposure compared to traditional film X-rays.
• Expert Radiologists: Your scans are interpreted by highly qualified, experienced consultant radiologists who specialize in musculoskeletal and thoracic imaging.
• Strict Quality Control: Dr. Essa Lab adheres to international quality standards, ensuring highly accurate and reproducible diagnostic results.
• Convenient Online Reports: Access your digital X-ray images and formal reports from the comfort of your home via our secure online portal and mobile app.
• Extensive Network: With numerous branches across Karachi and other major cities, finding a convenient location for your scan is simple.
• Patient-Centric Care: Our compassionate imaging technologists are dedicated to ensuring your comfort, safety, and privacy throughout the procedure.
• Affordable and Transparent Pricing: We offer high-quality diagnostic services at competitive rates, making premium healthcare accessible to everyone.