CTICasesPleural Effusion mimicking Post-Operative Aortic Rupture and Mediastinal Hematoma
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Imaging findings
Portable chest radiograph obtained two weeks after a mitral valve replacement shows an acutely widened mediastinum and an apparent apical cap on the left, concerning for an acute aortic rupture or post-operative mediastinal hematoma. CT of the chest demonstrates that the apparent mediastinal widening was a fake-out caused by a large, loculated pleural effusion hugging the mediastinum combined with adjacent compressive atelectasis.
Key takeaways
Pleural effions and compressive atelectasis in the immediate post-operative period can occasionally loculate along the mediastinal contours, mimicking life-threatening complications such as mediastinal hematoma, aortic dissection, or graft rupture on portable radiographs. Cross-sectional imaging with CT is essential to differentiate benign fluid collections from true vascular catastrophes.
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