A patient who has had the internal mammary artery harvested during a coronary artery bypass graft (CABG) surgery may experience anterior chest pain afterwards. This is due to trauma or irritation of the anterior intercostals nerve.


Clinical features:

(1) The patient has a history of harvesting one or both internal mammary arteries.

(2) The patient experiences one or more symptoms in the areas harvested:

(2a) burning and/or sharp pain in the anterior chest, which may radiate into the neck or axilla

(2b) numbness

(2c) hyperesthesia (making clothes or showers uncomfortable)

(2d) tenderness on palpation of the sternum and/or costochondral junction


The region typically affected is defined medially by the sternum, superiorally by the T2 or T3 intercostal space, laterally by the nipple line and inferiorally by the T5 or T6 intercostal space.


The symptoms are unilateral if only one artery was harvested (usually the left side) or bilateral if both arteries were.


Differential diagnosis:

(1) recurrent angina or myocardial infarction

(2) infection (such as sternal osteomyelitis)


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