Post-sternotomy intercostal artery pseudoaneurysm. Sonographic diagnosis and thrombosis by ultrasound-guided percutaneous thrombin injection

Abstract

Intercostal artery pseudoaneurysms are extremely rare. We present a case of an intercostal artery pseudoaneurysm after median sternotomy that was treated by ultrasound-guided percutaneous thrombin injection. They are a potential source of complications, especially haemothorax, and treatment is mandatory. Different methods may be used for the confirmatory diagnosis of false aneurysms. Doppler ultrasound (DUS) and CT are the two most commonly used methods, but pseudoaneurysms have also been diagnosed by means of arteriography (AR), which enables endovascular treatment of the pseudoaneurysm in a single procedure. We used Doppler sonography alone, because this technique yielded a definitive diagnosis without the need for other complementary imaging modalities to treat the lesion. There are various possible treatments for lesions of this kind. Endovascular embolization is the commonly used treatment for intercostal pseudoaneurysm but also stent grafting has been described. Surgical aneurysmectomy with proximal ligation of the intercostal artery is an option described for the treatment of the pseudoaneurysm. To date only seven cases have been published in the literature. Our case is the only published instance of treatment of an intercostal artery pseudoaneurysm by direct percutaneous thrombin injection under sonographic guidance.