CT Findings Following Thoracic Aortic Surgery

CT Findings Following Thoracic Aortic Surgery


Baskaran Sundaram, MB, BS, MRCP, FRCR ; Leslie E. Quint, MD ; Himanshu J. Patel, MD ; G. Michael Deeb, MD

1 From the Department of Radiology (B.S., L.E.Q.) and the Department of Surgery, Division of Cardiothoracic Surgery (H.J.P., G.M.D.), University of Michigan Health System, 1500 E Medical Center Dr, UMHS-Radiology, Cardiovascular Center #5481, Ann Arbor, MI 48109-5868. Recipient of a Magna Cum Laude award for an education exhibit at the 2005 RSNA Annual Meeting. Received January 5, 2007; revision requested March 1 and received May 4; accepted May 10. B.S. received a research grant from Bayer (Berlex); all remaining authors have no financial relationships to disclose.

Complications following thoracic aortic graft surgery are rare. They are not always clinically apparent and may occasionally be detected at computed tomography (CT) even in asymptomatic patients. Normal postoperative findings that may simulate complications include graft kinks, graft side branches, felt pledgets or rings, small amounts of low-attenuation perigraft material, native aortic wraps, and bovine pericardial wraps. Postoperative complications include anastomotic dehiscence and graft infection, which may lead to perigraft hematomas, pseudoaneurysms, abscesses, or fistulas. At CT, these complications may manifest as abnormally large collections of low-attenuation perigraft material, contrast material extravasation, perigraft gas collections, or fistulas to adjacent structures. Familiarity with both normal and abnormal postoperative CT findings and knowledge of the surgical technique used are essential to avoid misdiagnosing normal findings and to correctly diagnose potentially life-threatening complications. Following graft surgery, surveillance imaging may be needed, since the time of onset of complications seems highly variable.