CTICasesPseudoaneurysm of the Left Internal Mammary Artery Post-Aortic Valve Replacement
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Imaging findings
A soft tissue mass adjacent to the sternotomy wound was initially presumed to be a seroma or chronic hematoma. Ultrasound with color Doppler showed strong internal flow, indicating a vascular lesion. Subsequent CT angiogram confirmed a large pseudoaneurysm originating from the left internal mammary artery (IMA) near the sternotomy site. Post-treatment films demonstrated successful thrombosis of the pseudoaneurysm following endovascular embolization.
Key takeaways
This case highlights the critical importance of performing Doppler ultrasound on any superficial mass near a previous surgical site, especially after cardiothoracic surgery, to rule out a pseudoaneurysm before attempted percutaneous aspiration. Pseudoaneurysms, particularly of the IMA, are rare but serious complications of sternotomy or related procedures. This patient's pseudoaneurysm was successfully managed by transcatheter embolization, demonstrating an effective, albeit off-piste, approach by the cardiologists.
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