CTICasesAortic Root Pseudoaneurysms from Staphylococcal Endocarditis
Imaging findings
An older patient with a history of aortic stenosis and a thickened, calcified valve developed staphylococcal endocarditis. CT showed a contrast-filled structure adjacent to the left atrium initially mistaken for an accessory atrium, with slow flow ("smoke") on the arterial and even the left atrial side, actually representing a pseudoaneurysm arising from the aortic root; a second, separate pseudoaneurysm was present on the contralateral side of the root, producing a complex paired periaortic root pseudoaneurysm in the setting of the abnormal, possibly vegetation-bearing valve.
Key takeaways
Infective endocarditis involving an abnormal (stenotic, calcified) aortic valve can seed paravalvular tissue and produce periaortic root pseudoaneurysms that can mimic a normal cardiac chamber (accessory atrium) on CT; recognizing slow, smoke-like contrast flow within such a structure is a clue to differentiate a pseudoaneurysm from true cardiac anatomy, and these complex infected pseudoaneurysms typically require aortic root reconstruction in addition to treating the underlying bacteremia.
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