CTICasesAscending Aortic Graft Pseudoaneurysm with Pulmonary Artery Fistula
Imaging findings
CT demonstrates a large pseudoaneurysm adjacent to the ascending aortic graft in a patient with Marfan syndrome and prior aortic root replacement. A focal defect is identified at the anastomotic site of the graft. Retrospectively gated CT shows a flash of contrast opacifying from the pseudoaneurysm into the main pulmonary artery, indicating a direct fistulous connection. The contrast enhancement appears preferentially in the right pulmonary artery, consistent with the jet from the aorto-pulmonary fistula being directed toward the right. Surgical exploration confirmed the aorto-pulmonary fistula.
Key takeaways
Pseudoaneurysm at an ascending aortic graft anastomosis can rarely develop a fistulous connection to the adjacent main pulmonary artery, driven by the high pressure differential. This aorto-pulmonary fistula may be detected on retrospectively gated CT by visualization of a contrast jet from the pseudoaneurysm into the pulmonary artery lumen. Without gating and contrast timing, the fistula might not be detectable. The preferential opacification of the right pulmonary artery reflects the direction of the jet. This rare complication requires urgent surgical correction.
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