CTICasesInfected Aortic Graft with Pseudoaneurysm
Imaging findings
Preoperative imaging shows a patient with a mechanical prosthetic aortic valve and ascending aortic root repair. Follow-up CT three months later for fever reveals a new, rim-enhancing fluid collection surrounding the aorta, extending along the graft from the root to the distal anastomosis, with associated mediastinal fat inflammation. Subsequent serial imaging shows persistence and enlargement of this perigraft fluid collection. A gated study days later demonstrates active extravasation of contrast into the collection, with the epicenter at the distal anastomosis, confirming an infected graft complicated by a distal pseudoaneurysm. Blood cultures grew *Staphylococcus aureus*.
Key takeaways
Post-operative perigraft fluid collections should typically stabilize or resolve; an increase in size or a new rim-enhancing fluid collection, especially with inflammation and active contrast extravasation, is highly indicative of an infected graft with potential pseudoaneurysm formation. It is important to compare with original studies, as benign inflammatory reactions usually stabilize or decrease. Infected foreign bodies like grafts pose a high risk of rupture and typically require surgical intervention.
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