CTICasesAscending Aortic Graft Dehiscence with Chest Wall Erosion
Imaging findings
CTA in an 86-year-old patient with prior ascending aortic graft repair (1970) and mechanical valve replacement (1974) demonstrates marked dehiscence of the proximal graft anastomosis with contained active hemorrhage leaking through the anterior mediastinum, around the sternum, and into the chest wall. There are also large pseudoaneurysms at the aortic root level.
Key takeaways
Late dehiscence of an ascending aortic graft anastomosis can present with contained rupture tracking into the mediastinum and chest wall, producing a pulsatile visible or palpable mass. This once-classic presentation of a "pulsating sternal mass" was historically associated with syphilitic aortic aneurysm eroding the sternum, but can now be seen with late anastomotic failure in patients with prior aortic repair.
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