CTICasesPost-CABG Saphenous Vein Graft Pseudoaneurysm and Chest Wall Hematoma
Imaging findings
Chest CT shows an extensive, high-density fluid collection representing a hematoma tracking through the anterior chest wall and mediastinum following coronary artery bypass graft surgery. A small, focal outpouching of contrast-filling is identified at the distal aspect of the saphenous vein graft to the posterior descending artery, consistent with a graft pseudoaneurysm. Selective angiography confirmed active extravasation, which was successfully treated with a covered stent.
Key takeaways
Post-operative pseudoaneurysms of coronary artery bypass grafts are rare but potentially life-threatening complications that can present with severe chest wall hematomas or mediastinal hemorrhage. They can occur due to mechanical trauma during sternotomy or wiring, suture line failure, or infection, and can be treated percutaneously via covered stent placement.
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