CTICasesAortic Graft Dehiscence and Coronary Napkin Ring Sign
[...]. Aortic Graft Dehiscence and Coronary Napkin Ring Sign. CTICases. Published January 13, 2017. https://cticases.com/c/n2w36
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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