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A 70 year old woman presented to her general practitioner with a swelling on the anterior chest wall after mitral valve replacement.replacement. The general practitioner attempted to aspirate the swelling, but it recurred spontaneously. She was referred for further investigations, which showed that the swelling communicated with the branches of the right internal mammary artery. She was treated with selective embolisation and subsequent surgical evacuation.
Pseudoaneurysms are not uncommon after wiring of the sternum, which is the most popular method of closing sternotomy wounds. They can be embolised or stented, but stenting is considered preferable because it does not interrupt the distal blood supply. They are associated with a high risk of bleeding because of communication with deeper structures.