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Case Reports
. 2024 Dec 17;11(2):101714.
doi: 10.1016/j.jvscit.2024.101714. eCollection 2025 Apr.

Intercostal pseudoaneurysm after median sternotomy treated with percutaneous thrombin injection

Jack F Donaghue  1 , Kirthi S Bellamkonda  2 , Bjoern D Suckow  2 , Jock N McCullough  2
Affiliations
Case Reports

Intercostal pseudoaneurysm after median sternotomy treated with percutaneous thrombin injection

Jack F Donaghue et al. J Vasc Surg Cases Innov Tech. .

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.

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Conflict of interest statement

None.

Figures

Fig 1
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
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.
See this image and copyright information in PMC

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