Giant True Aneurysms of Saphenous Vein Bypass Grafts
A Rare Cause of Tumor-Like Mediastinal Masses
A 69-year-old man, who had been asymptomatic for 12 years after aorto-coronary venous bypass surgery, was admitted for the evaluation of a large mass adjacent to the left heart border detected by routine chest radiography (Figure 1). Further diagnostic evaluation included a contrast-enhanced multi-detector row spiral computed tomography scan of the chest that revealed a large left anterior mediastinal mass abutting the left ventricle, right ventricle, and pulmonary artery (Figure 2). In addition, a second mass adjacent to the ascending aorta and the right atrium was detected. Both structures were partly filled with contrast agent, confirming their vascular nature. On the basis of these findings, giant aneurysms of the venous grafts to the left circumflex coronary artery and to the right coronary artery were assumed and the patient was scheduled for surgical excision and revascularization. Two days before surgery, the patient died suddenly because of to rupture of an infrarenal abdominal aortic aneurysm. Autopsy (Figure 3) confirmed the diagnosis of true giant aneurysms of the 2 saphenous vein bypass grafts. Both lumina were largely replaced by thrombus. The third bypass graft to the left anterior descending coronary artery was inconspicuous.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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