Sternal Pseudoaneurysm After Cardiac Surgery

This report reviews a rare case of a presternal pseudoaneurysm after cardiac surgery.

An 80-year-old male patient presented with a large lump over the manubrium at the upper end of his sternal wound. Two months previously, the patient electively received a tissue aortic valve replacement, and ascending aorta repair for an incidental 6-cm ascending aorta aneurysm and aortic regurgitation. Ultrasound examination revealed a pulsatile Doppler flow (swirling yin/yang) in a 2- × 6-cm lump, confirming the presence of a pseudoaneurysm. On arterial computed tomography imaging, the presternal pseudoaneurysm was found to be arising from a branch of the right internal mammary artery. The patient underwent urgent open repair, with the cause found to be rubbing of a residual sternal wire on the right internal mammary artery.

The case highlights the key imaging findings of sternal pseudoaneurysms after cardiac surgery and also provides a literature review of surgical and endovascular management.