Interesting caseDeep sternal wound infection 1

• Female 82 years old

• 31/8/54 : Admitted at Songkhla hospital due to progressive dyspnea. Orthopnea. PND. Dx CHF => Treated with Lasix IV.

• CXR : Widening mediastinum+Mediastinal mass.

• CT chest 1/9/54 : Dissecting aneurysm of AAo and DAo down to abdominal aorta below renal bifurcation.

• Referred to PSU hospital.

• At ER : Full consciousness. Well opeartion. No fever. no chest pain.

• U/D : HT, Dyslipidemia.

• No drug nor food allergy.

• PE : BP 128/60 mmHg, HR 102 /min, RR 24 /min, BT 36.8’C, SpO2 94% RA.

• Full consciousness. Morbid obesity.

• HEENT : Not pale. No jaundice. Engorged neck vein.

• Heart : No murmur.

• Lungs : Equal breath sound.

• Abd : Soft. Not tender.

• Ext : Pitting edema 1+

Preop CXR

Thoracic aortic dissection type A

Set OR for Ascending aortic replacement

Immediate postop

Postop 4 hr

Set OR for stop bleeding

Postop day 10

• Still on mechanical ventilator.

• Serum oozing per sternal wound, serosanguinous color soaked gauze.

• Off staples มี serum พุ่งออกมาตาม heart pumping.

• No fever.

Postop day 10

Set OR for irrigation and debridement then

placing retention sutures

Postop day 3

Set OR for irrigation and debridement

with omental graft

Immediate postop

Postop day 5

Postop day 10

Sudden cardiac arrest at postop

2 months