CTICasesAortic Injury with Organized Mediastinal Hematoma after Atrial Fibrillation Ablation
Imaging findings
A patient who had atrial fibrillation ablation months earlier developed chest discomfort with mediastinal widening and bilateral pleural effusions. CT shows a large mass around the aorta leaning on the left atrium, with the aorta of good caliber and only mild atherosclerosis; the esophagus is flattened and compressed by the mass but intact, with central luminal (not ectopic) gas. MRI shows a complex T2-bright collection in the right pleural space, consistent with an organized hematoma, and a stent was placed in the descending aorta though no leak was demonstrated.
Key takeaways
Aortic injury is a rare but recognized complication of left atrial ablation, producing a high-pressure organized mediastinal hematoma; the esophagus offers less protection to the aorta than assumed. The high-pressure appearance argues against a low-pressure atrial source, and confirming an intact esophagus (by esophagram) helps localize the injury to the aorta. Ablation complications, though individually uncommon, are seen regularly at high-volume centers.
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