Aorto-coronary bypass graft aneurysms

Case contributed by Dr Ivan Plachkov
Diagnosis certain


Chest CT following abnormal chest x-ray findings.

Patient Data

Age: 60
Gender: Male

CT chest angio coronal &...


CT chest angio coronal & saggital reconstructions

CT chest angiography of an elderly male with abnormal chest x-ray findings following aorto-coronary bypass surgery ten years ago. The study shows multiple coronary artery grafts aneurysms affecting two of the venous ones.LIMA-LAD is intact. There are multiple partially thrombosed aneurysms involving the RCA venous bypass which is tortuous.A large thrombosed aneurysm is seen it he left circumflex venous graft measuring 90/50mm.There is minor enhancement of the graft lumen distal to the aneurysm.The brachiocephalic trunk is missing.An aberrant right subclavian artery is present, crossing behind the esophagus. The right common carotid artery has a separate coarse, passing in front of the trachea. A fusiforme thrombosed aneurysm is evident involving the proximal right subclavian artery.The aneurysm involves approximately 7cm of the vessel lenght.

Case Discussion

The case shows coronary arteries grafts aneurysms as a complication following bypass surgery ten years ago (LIMA-LAD, SVG-D1, RCX, RCA).

Thrombosed aneurysms involving right and left circumflex venous grafts are seen. The patient also has proximal right subclavian artery aneurysm and supraaortic vessel variation. CT angiography is valuable method in such rare conditions mimicking mediastinal mass on plain films.

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