Findings
Chest radiograph
- Small pleural effusions
- Patchy bibasilar airspace opacification
CT
Chest
- Changes of median sternotomy for ascending aorta and hemiarch graft repair of an ascending aortic aneurysm
- Fluid throughout the mediastinum with areas of peripheral enhancement as well as intermixed small volume pneumomediastinum
- Aortic dissection extending distally from the proximal descending thoracic aorta with resultant aneurysmal dilation of the descending aorta measuring up to 4.2 cm in diameter just superior to the diaphragmatic hiatus
- Small contrast-filled outpouching along the anterior aspect of the distal ascending aorta aspect of the graft, which may represent a residual stump from a native great vessel origin
- Mild coronary artery calcifications
- Moderate-sized bilateral pleural effusions with overlying atelectasis
Abdomen/Pelvis
- Aortic dissection continues into the left common and proximal left internal iliac arteries without occlusion of the true lumen, with the largest diameter of the aorta measuring 4 x 3.5 cm just proximal to the celiac artery origin
- Partial, diluted contrast opacification of the false lumen at and above the level of the diaphragmatic hiatus with more robust enhancement distally with multifenestrated communications between the true and false lumens
- Both left renal arteries arise from the false lumen and may have slightly decreased density of contrast compared to the right renal artery
- The celiac artery, SMA and right renal artery all arise from the true lumen
- Left renal atrophy
- Mild right greater than left perinephric stranding
- Nonobstructing 3 mm right lower pole renal calculus
- Gas within the urinary bladder
- Vasectomy clips
MSK
- Recent median sternotomy changes without bony dehiscence
- No drainable subcutaneous collection
Diagnosis
Mediastinitis
Sample Report
Recent changes of median sternotomy for ascending aorta and hemiarch graft repair of an ascending aortic aneurysm. Mediastinal fluid and gas is more than expected one week after surgery and raises concern for mediastinitis/developing mediastinal abscess. No evidence of overlying surgical site dehiscence or subcutaneous collection.
Aortic dissection extending from the proximal descending thoracic aorta through the left common and internal iliac arteries, with associated aneurysmal aortic dilation measuring up to 4.2 cm just above the diaphragmatic hiatus.
Moderate-sized pleural effusions with overlying atelectasis.
Asymmetric left renal atrophy, which may be the result of chronic arterial insufficiency given that both left renal arteries arise from the false lumen.
Nonspecific right greater than left perinephric stranding. Recommend correlation with urinalysis for signs of urinary tract infection. Gas within the urinary bladder presumably relates to recent catheterization if there is history of such.
Discussion