CTICasesAortopulmonary Fistula with Aortic Graft Dehiscence and Pseudoaneurysm
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Imaging findings
A patient, 6 weeks post-repair of a type A aortic dissection (valve-sparing ascending and hemiarch repair), presents with syncope and shortness of breath. CTA reveals extensive perigraft fluid, pseudoaneurysms originating from both proximal and distal anastomotic sites of the graft, indicative of graft dehiscence and contained rupture. A subtle but clear hole with an arterial jet is seen between the ascending aorta and the pulmonary artery, signifying an aortopulmonary fistula. Felt reinforcement pledgets are also visible.
Key takeaways
Aortic graft dehiscence is a serious complication that can lead to pseudoaneurysm formation and, as demonstrated here, an aortopulmonary fistula. This fistula, characterized by a direct communication between the ascending aorta and pulmonary artery, can be a consequence of the extensive dissection required during surgery or related to suture lines and reinforcement sites. While a mycotic origin was considered, the exact cause for this fistula, even without a cannulation history, remained somewhat mysterious but is a recognized, albeit uncommon, post-operative complication.
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