Causes of Sternum Crepitus

Primary Causes

The American College of Radiology states that sternum crepitus is most commonly caused by sternal osteomyelitis, sternal fracture, post-sternotomy complications, or soft tissue infections with gas-forming organisms 1, 2
Sternal wound infections following cardiac surgery can cause sternum crepitus, with sternal dehiscence or nonunion (sternal gap >3mm) correlating with higher chest pain intensity, according to the American College of Radiology 3
Pathologic fractures, such as those from metastatic disease, can cause sternum crepitus, as reported by the American College of Radiology 3
Stress fractures can also cause sternum crepitus, as noted by the American College of Radiology 1
Necrotizing fasciitis involving the chest wall can cause sternum crepitus, as reported by the World Journal of Emergency Surgery 4, 5
Gas-forming soft tissue infections in the absence of trauma or puncture wound are a reliable indicator of infection, according to the American College of Radiology 1
Subcutaneous emphysema from trauma or infection can cause sternum crepitus, as noted by the American College of Radiology 1
Costochondritis, inflammation of costal cartilages, can cause sternum crepitus, as reported by the American College of Radiology 3
Radiation-induced chest wall injury, following treatment for breast or lung cancer, can cause sternum crepitus, according to the American College of Radiology 3

The American College of Radiology recommends radiographs as first-line imaging to detect soft tissue gas and bony abnormalities 1, 2
CT is the most sensitive modality for detecting soft tissue gas and determining its extent and location, as reported by the American College of Radiology 1
MRI with contrast is preferred for suspected osteomyelitis, according to the American College of Radiology 1, 2
FDG-PET/CT can help differentiate between osteomyelitis and reactive inflammation, as noted by the European Journal of Nuclear Medicine and Molecular Imaging 6
Patterns of infection on imaging, such as focal uptake extending to adjacent soft tissue or sternal wire uptake, can indicate sternal osteomyelitis, as reported by the European Journal of Nuclear Medicine and Molecular Imaging 6
Soft tissue gas on imaging indicates infection in the absence of trauma or puncture wound, according to the American College of Radiology 1

Crepitus in the absence of recent surgery, trauma, or puncture wound is a reliable indicator of infection, as noted by the American College of Radiology 1
Diffuse, homogeneous uptake confined to the sternum can persist for months to years after surgery without infection, as reported by the European Journal of Nuclear Medicine and Molecular Imaging 6
Gas in deep fascial planes is a hallmark of necrotizing fasciitis and requires urgent surgical intervention, according to the American College of Radiology 1
Sternal nonunion with a gap >3mm correlates with significantly higher chest pain intensity, as reported by the American College of Radiology 3
Fracture-related uptake on imaging usually normalizes within 3 months of trauma, as noted by the European Journal of Nuclear Medicine and Molecular Imaging 6