Metastatic renal carcinoma presenting with profuse haemorrhage at cardiac surgery

A 62-year-old man undergoing coronary artery bypass grafting sustained profuse unexplained haemorrhage during sternal diathermy before sternotomy. Histology of tissue from the sternum suggested metastatic renal carcinoma. A primary renal tumour was subsequently identified. Sternal metastases are rare, often highly vascular, and arise particularly from thyroid or renal tumours. In the absence of angiographic evidence of an eroding aortic aneurysm, sternal metastases represent the most likely cause of unexplained haemorrhage during sternotomy.