CTICasesPseudoaneurysm and Transient Aortic Occlusion following Coarctation Repair
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Imaging findings
Non-contrast and contrast-enhanced CT scans of a patient with a history of surgical coarctation repair show a large, complex pseudoaneurysm or surgical dehiscence at the proximal anastomosis of an interposition graft. There is high-attenuation hematoma surrounding the graft. On initial presentation, the distal aortic lumen is severely compressed. Follow-up CT scans show a highly dynamic process, with transient re-expansion of the narrowed aortic lumen after three days, followed by near-complete aortic occlusion one month later.
Key takeaways
Late complications of surgical coarctation repair include pseudoaneurysm formation, graft dehiscence, and aortic dissection or occlusion. This case highlights a catastrophic presentation of transient aortic occlusion from a regional hematoma or pseudoaneurysm, which led to spinal cord ischemia and temporary paraplegia that became permanent after complete aortic occlusion. Endovascular stenting can be used to re-expand the compressed true lumen and exclude the pseudoaneurysm.
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