Demonstration of Multislice Computed Tomography of Graft Destruction and Rupture to the Pericardium After Replacement of Ascending Aorta for Stanford Type-A Dissection
A 57-year-old man went to a hospital complaining of chest pain and was diagnosed with a Stanford Type-A aortic dissection that continued through the aortic arch and descending aorta to the whole abdominal aorta. He therefore underwent graph replacement of the ascending aorta.
After 1 month, he experienced dyspnea and came to our hospital. Chest x-ray revealed cardiac enlargement. Transthoracic echocardiogram revealed massive pericardial effusion (PE) but no cardiac tamponade. An enhanced multislice computed tomography (CT) scan revealed massive PE with partially high CT values centrally located only in the right side of the heart and compressing only the right atrium (RA) (Figure 1). There was leakage of contrast material from the graft located at the ascending aorta (AAo) (Figure 1A). Maximum-intensity projection images from the left anterior oblique projection revealed the destruction of the graft and leakage of contrast material from the AAo to the pericardium, as well as the location of the leakage, which included the right coronary artery (Figure 2). The occurrence of localized massive PE might have been due to localized adhesions of the pericardium caused by the previous surgery. Therefore, leakage from the destroyed graft flowed into the restricted PE space only on the right side of the heart, compressing only the RA and avoiding cardiac tamponade. The presence of high CT values in massive PE might indicate partial coagulation. The graft was repaired surgically by suturing with good results. The PE was found to contain partially coagulated blood, as we speculated from CT images.