CTICasesInfected Ascending Aortic Graft (Culture-Negative)
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Imaging findings
Chest x-ray shows a widened mediastinum in a patient with a prior ascending aortic graft for Type A dissection. CT reveals a subcutaneous fluid collection and extensive fluid surrounding the ascending aortic graft. Despite initial suspicion of pseudoaneurysm, follow-up CT with arterial and delayed phases shows the graft itself is intact with no active extravasation and patent anastomoses. However, findings concerning for infection include internal mammary and paratracheal lymphadenopathy, with the subcutaneous collection not appearing acutely hemorrhagic. Intraoperatively, purulent subcutaneous and perigraft tissue was found.
Key takeaways
Aortic graft infection is a serious complication, often presenting with constitutional symptoms and imaging findings of perigraft fluid collections and localized inflammation (e.g., lymphadenopathy). While active extravasation or pseudoaneurysm formation can indicate infection, the absence of these doesn't rule it out. Culture-negative infections are possible, especially if the patient received prior antibiotics, but clinical context (constitutional symptoms, inflammatory markers) and purulent findings confirm the diagnosis.
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