A 63-year-old woman presented with a 1-month history of progressing sternal mass. She underwent mechanical aortic valve replacement (AVR) with a St Jude 19 mm valve (St. Jude Medical, Saint Paul, MN) and Manougian annulus enlargement technique 10 years ago for aortic stenosis. She had an unremarkable clinical follow-up and a normal transthoracic echocardiography (TTE) 5 years ago. Four months before the current event, she had a transient episode of severe chest pain for which she did not seek medical attention. Physical examination revealed a pulsatile sternal mass and a IV-VI grade murmur with a thrill. There was no evidence of infection; she had normal blood analyses and negative blood cultures. Chest radiography showed enlarged mediastinum with a broken sternal wire. Transesophageal echocardiography showed normal AVR function with minimal regurgitation (Fig. 1). Computed tomography angiography (CTA) revealed a large aortic pseudoaneurysm measuring 10.5 × 5.4 × 6.7 cm originating from the aortic annulus and extending through the sternum to the subcutaneous tissues (Fig. 2). Soft tissue (35 to 50 Hounsfield units pre- and postcontrast) was observed within the pseudoaneurysm, most in keeping with a mural thrombus. There was a partial compression of the right pulmonary artery and right atrium. The patient remained hemodynamically stable throughout the investigations.
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Published online: February 02, 2023
Accepted: January 29, 2023
Received: June 12, 2022
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