CTICasesCoiled Ascending Aortic Pseudoaneurysm Post-Dissection Repair
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Imaging findings
Chest x-ray reveals a prior sternotomy with coronary artery bypass grafting and a huge, globular mass of coils in the right mediastinum, projecting adjacent to the ascending aorta on the lateral view. CT confirms a very large, coil-packed pseudoaneurysm of the ascending aorta, which had developed after an emergent Type A dissection repair and CABG. The pseudoaneurysm demonstrated communication at multiple sites, including the distal suture line of a hemi-arch replacement and near the right coronary button and aortic root.
Key takeaways
Ascending aortic pseudoaneurysms are a known complication after aortic surgery, particularly for dissection repair. They can be complex with multiple communications. Endovascular coiling may be attempted in high-risk surgical patients, but significant pseudoaneurysms often require re-operation. Imaging (CT) is essential for delineating the anatomy, extent, and communications of such lesions.
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