X-ray
Frontal
Name this sign?
Hilum overlay sign, suggesting this mass is either in the anterior or posterior mediastinum.
Patient has undergone previous sternotomy with wires. There are 2 SVG ring markers. Clips are seen along the LIMA and LAD. There is moderate to severe enlarged cardiopericardiac silhouette.
In the aortic pulmonary window there is a 6 x 9 cm density-masslike with clear smooth borders. This mass is displacing the LIMA surgical clips laterally, suggesting also this is a SVG aneurysm.
Findings consistent with hilum overlay sign-suggesting this lesion is either in the anterior or posterior mediastinum.
There is elevation of the left hemidiaphragm, suggesting there is left phrenic nerve palsy, either from this mass-like lesion or from prior surgery.
Also seen are multiple left rib fractures.
Emphysematous chest.
IMPRESSION:
Differential diagnosis for this mass like lesion,is likely in anterior or posterior mediastinum including aortic aneurysm or aneurysm within the saphenous venous graft. The saphenous venous grafts were completely occluded on cardiac catheterization.
Patient is elderly, had cardiac catheterization yesterday with more plans for cardiac catheterization, a noncontrast CT scan of the chest will be performed to start with.