Intercostal pseudoaneurysm after median sternotomy treated with percutaneous thrombin injection

Abstract

Intercostal artery pseudoaneurysm is an exceedingly rare complication seen after chest wall insult, either through trauma or operative procedures. We present a case of a 74-year-old man with mitral regurgitation and aortic stenosis who underwent aortic and mitral valve replacement via sternotomy. At the 1-month follow-up, a 1-cm pulsatile mass was noted adjacent to the left of the sternotomy in the sixth intercostal space. Concern for a pseudoaneurysm of the intercostal artery prompted evaluation with ultrasound, which demonstrated a pseudoaneurysm originating from an intercostal artery. This unusually located pseudoaneurysm was treated with ultrasound-guided thrombin injection with complete resolution.

Keywords: Cardiac surgery; Intercostal pseudoaneurysm; Median sternotomy; Thrombin injection.

Fig 1

Supplies for thrombin injection. (A) Chlorhexidine skin prep. (B) Thrombin and diluent. (C) A three-way stopcock. (D) Lidocaine (1%). (E) AN 18G access needle. (F) A 25G infiltration needle. (G) Blunt-fill needle. (H) A 5-mL syringe. (I) Sterile saline flush. (J) Sterile ultrasound gel.

Fig 2

Before (left) and during (right) thrombin injection, with needle visible entering intercostal artery pseudoaneurysm (ICPSA) at the bottom right of image and thrombus within the sac.