CTICasesEnormous Aortic Pseudoaneurysm Eroding Sternum Post-Aortic Valve Replacement
Imaging findings
Initial CT (2014) showed a small pseudoaneurysm near the aortic annulus at the anastomosis of an aortic valve replacement, with a clear communication. A follow-up radiograph (October 2014) showed an extra convexity along the aorta. CT at that time revealed a larger pseudoaneurysm, still communicating, with a palpable anterior chest wall abnormality and erosion through the sternum (sternal wires remained aligned, suggesting external erosion). By 2015, the pseudoaneurysm was enormous, with contrast extending through the sternal wire space into the subcutaneous tissues.
Key takeaways
This case depicts the dramatic natural history of a large pseudoaneurysm originating from the aortic annulus post-aortic valve replacement. It demonstrates aggressive progressive enlargement and erosion through the sternum and chest wall over time. Although often associated with infection (e.g., mycotic aneurysms), this particular case was not infected, highlighting the powerful erosive capability of a high-pressure pulsatile collection on bone.
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