LAUSR

A 66-year-old man suffering from autoimmune myositis underwent a sternal bone marrow puncture. The procedure was performed by an experienced hematologist. Pulsatile bleeding occurred immediately after the internal needle was removed. The needle was immediately replaced (Fig. 1). A contrast-enhanced thoracic computed tomography (CT) scan with 3D reconstruction was performed. The CT scan revealed that the needle was penetrating the ascending aorta, through venomous trunk (Figs. 2, 3). The median distance between the skin surface and the aorta is typically 23.6 and 21.3 mm in men and women, respectively. It was around 32.8 mm for our patient, while the length of our needle was 30 mm (Fig. 4). Life-threatening complications following sternal bone marrow puncture are exceeding rare. Few cases have been described involving lung or heart puncture. Risk factors for such complications are physician inexperience, incorrect location of puncture, sternal lytic areas, and incorrect needle length. Those life-threatening complications required immediate high-performance CT scan before urgent surgical management. The patient had a mini-sternotomy to remove the trocar and repair the aorta.