CTICasesLarge Ascending Aortic Pseudoaneurysm Mimicking a Coronary Artery Aneurysm
Imaging findings
A chest radiograph in a patient with sternotomy wires and a prior valve replacement shows a large, well-rounded, partially calcified mediastinal mass initially suspected to represent a coronary artery aneurysm. CT instead shows a large pseudoaneurysm arising from a focal defect in the ascending aortic wall just above the sinotubular junction, largely thrombosed and calcified, present since a valve replacement performed roughly 20 years earlier.
Key takeaways
A rounded, partially calcified mediastinal mass adjacent to the heart in a patient with prior cardiac surgery should not automatically be assumed to be a coronary artery aneurysm -- a chronic, largely thrombosed ascending aortic pseudoaneurysm at a prior surgical anastomosis or cannulation site can mimic this appearance and may go undetected for decades.
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