CASE REPORT   

Il Giornale Italiano di Radiologia Medica 2018 Luglio-Agosto;5(4):578-82

DOI: 10.23736/S2283-8376.18.00077-3

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: Italian

Double pseudoaneurysm of the aortic root with ascending aorta replacement by composite valve graft: ECG-gated CT angiography before and after reintervention

Mario FINAZZO ¹ ✉, Cristiana DURANTI ², Francesca INTERLICCHIA ³, Gianfranco FILIPPONE ⁴, Michela ANTONUCCI ⁵, Domenico MESSANA ²

¹ Studio di Radiologia Finazzo S.r.l., Palermo, Italia; ² Unità Operativa di Radiodiagnostica, ARNAS Civico Di Cristina Benfratelli, Palermo, Italia; ³ Unità Operativa Complessa di Radiologia, Ospedale Umberto I, Siracusa, Italia; ⁴ Unità Operativa di Chirurgia Vascolare, ARNAS Civico Di Cristina Benfratelli, Palermo, Italia; ⁵ Dipartimento di Diagnostica per Immagini, Azienda Ospedaliera Universitaria Policlinico, Palermo, Italia

Pseudoaneurysms are a rare complication of aortic root replacement. We report a case of double pseudoaneurysm of the aortic root located in the coronary arteries anastomosis site. The patient had undergone aortic root and ascending aorta replacement by composite valve graft twelve years before and was assessed by ECG-gated CT angiography before and after surgical re-intervention. Retrospective ECG gating was used in both examinations to minimize motion artifacts at the aortic root. CT angiography provided critical information in the planning of surgical re-intervention. It allowed an accurate definition of the location of the pseudoaneurysms with respect to the coronary arteries, the aortic root and the sternum. In detail, if they were anterior and situated less than 2 cm from the sternum. After surgical re-intervention, it ruled out substantial abnormalities, but a moderate stenosis of the anastomosis between the right coronary artery and saphenous vein autologous segment. Lastly, the detection of hyper-attenuating surgical material on non-enhanced images and the comparative assessment with contrast-enhanced images helped to avoid a misdiagnosis of pseudoaneurysm or contrast extravasation.

KEY WORDS: False aneurysm - Aorta - Computed tomography angiography