CTICasesPseudo-retrosternal Abscess
Imaging findings
In a 66-year-old post-CABG patient who required a hemostatic agent for intraoperative bleeding, CT showed a collection in the upper retrosternal fat with a dense outer rim and low-attenuation material inside, plus tiny pockets of air on lung windows. The surrounding fat appeared normal without inflammatory stranding — atypical for a true abscess.
Key takeaways
Topical hemostatic agents such as Gelfoam can closely mimic a postoperative abscess or fluid collection on chest CT. Operative notes should be checked whenever a suspected abscess appears on imaging without classic infection signs like stranding or enhancement. Though more commonly reported in the abdomen, retained hemostatic material should be considered in the differential for suspicious thoracic masses following cardiothoracic surgery.
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