A 47-year-old man was admitted to the clinic with histologically diagnosed thymoma of the anterior mediastinum, pT3N0M1a, stage IYA, type B3. He underwent surgery for primary tumor resection through a median sternotomy and left thoracotomy at the 7th intercostal space to remove pleural metastases. On the first postoperative day, massive bleeding occurred, a resternotomy was carried out but failed to save the patient. A fracture of the right first rib, which injured the right vertebral artery, had caused massive bleeding and was diagnosed at autopsy. Surgeons should keep in mind this potentially fatal complication of a median sternotomy.
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