Middle-aged woman several years out from coronary artery revascularization for coronary artery disease presenting with gradually worsening exertional dyspnea.
Describe the radiographic findings of concern. What is your leading diagnostic consideration?
What should be done next?
Describe the radiographic findings of concern. What is your leading diagnostic consideration?
What should be done next?
Imaging Findings PA (Fig. 1A) and lateral (Fig. 1B) chest radiography reveals post-operative changes reflective of an antecedent sternal splitting thoracotomy and coronary artery revascularization. Although the cardiomediastinal appears grossly unremarkable on the frontal exam (Fig. 1A), the lateral exam (Fig. 1B) reveals an ovoid 2.0 cm opacity in the retrosternal clear space in close proximity to the base of post-operative heart in the anterior mediastinal compartment. Select images from a contrast-enhanced chest CT (Fig. 2A-2F) (mediastinal windows) performed 3 days latter shows this radiographic opacity in question is created by a focal pseudoaneurysm emanating off the ascending aorta at the 10:00-11:00 position at the aortic cannulation site.
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