Pulmonary outflow stenosis due to saphenous vein graft aneurysm: a rare case report and review of literature

Abstract

Saphenous Vein Graft Aneurysms (SVGA) have been reported as a rare complication of post-coronary artery bypass grafting (CABG) in the literature. Complications typically arise 10 to 20 years post CABG. Acquired pulmonary artery trunk stenosis in adults is another rare entity that may be caused by a SVGA, among other etiologies. The finding was incidentally discovered on CTA performed to rule out pulmonary embolism on a post hip-fracture repair patient who was experiencing shortness of breath. The diagnosis was confirmed by CTA coronary study with multiple 3-D rotational volumetric-surface shaded images. Therefore cross sectional imaging can give early and accurate measurements of the size of an aneurysm and its relationship to adjacent structures, emphasizing its added value in early diagnosis of SVGA.

Ruptured saphenous venous graft pseudoaneurysm presenting as a pulsatile chest mass

“…Patients may present with chest pain, heart failure, or mass effect due to the compression of cardiac chambers and mediastinal structures. 4,5 Pseudoaneurysm rupture has also been described in case reports. 6 Cases presenting early after surgery are believed to be due to poor surgical technique, infection, and inflammation whereas the etiology in late presenting cases is believed to be delayed suture dehiscence.…”

“…There is wide variation in clinical presentation. Patients may present with chest pain, heart failure, or mass effect due to the compression of cardiac chambers and mediastinal structures . Pseudoaneurysm rupture has also been described in case reports .…”