CTICasesAortic Graft Dehiscence and Coronary Napkin Ring Sign
Imaging findings
CT angiography shows dramatic dehiscence and rupture of an ascending aortic graft with extensive surrounding mediastinal hemorrhage extending intrapericardially and epicardially. Within the coronary circulation, there is a clear napkin ring sign in a coronary artery plaque, characterized by a low-attenuation necrotic core surrounded by a higher-attenuation rim of tissue.
Key takeaways
Aortic graft dehiscence is a catastrophic complication of surgical replacement that presents with significant perigraft and mediastinal leakage. In the coronary arteries, the napkin ring sign is a specific imaging feature of a highly vulnerable plaque with a large lipid-rich necrotic core and a thin fibrous cap, a key marker of high cardiovascular risk under the CAD-RADS reporting system.
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