Sternal erosion detected by computed tomographic angiography before repeat sternotomy in an adolescent with congenital heart disease

The case of a 17-year-old male with congenital heart disease who was found to have erosion of a pseudoaneurysm into his posterior sternum is presented. The pseudoaneurysm originated from a right ventricle-to-pulmonary artery homograft, which had been placed 11 years before. It had not been appreciated by echocardiography. The pseudoaneurysm and erosion were visualized with computed tomographic angiography before scheduled surgical replacement of the homograft. This unexpected finding was critical for operative planning and was confirmed on direct visualization in the operating room.