EURORAD ESR

Case 11745

Aneurysm of a right coronary artery bypass graft (CABG): Saphenous Vein Graft (SVG)

Author(s)
Amir Awwad, Yutaro Higashi, Lisa Hamilton, Maruti Kumaran

Nottingham Univ. Hospitals,
Queen's Medical Centre,
Radiology Department,
Derby Road, Nottingham;
Email:amirawwad@hotmail.com
 
Patient
male, 77 year(s)
 
 
  • Figure 1
    Chest radiograph
     

    A recent plain radiograph showing an unusual contour to the right side of the heart. Further assessment with cross-sectional imaging was recommended. Elsewhere the lungs are clear, previous median sternotomy noted.

     
    Area of Interest: Arteries / Aorta; Cardiac; Cardiovascular system; Imaging Technique: Plain radiographic studies; Procedure: Diagnostic procedure; Special Focus: Aneurysms; Grafts;

    An old chest radiograph (2 years before) showing the abnormality which was thought then to be a hiatus hernia. However, it has an exaggerated dense contour if compared with the subsequent recent image.

     
    Area of Interest: Arteries / Aorta; Cardiac; Cardiovascular system; Imaging Technique: Plain radiographic studies; Procedure: Diagnostic procedure; Special Focus: Aneurysms; Grafts;
     
     
  • Figure 2
    Arterial phase multi-planar CT
     

    PV scan (axial image) confirming a large (7.5 x 6.4 x 10.2 cm) right coronary artery SVG aneurysm (arrow) with localised anterior mass effect indenting the right atrium (RA), ventricle (RV) and atrioventricular (AV)...

     
    Area of Interest: Cardiac; Cardiovascular system; Vascular; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Aneurysms; Grafts;

    PV scan (coronal image) confirming a large (7.5 x 6.4 x 10.2 cm) right coronary artery SVG graft aneurysm with localised anterior mass effect indenting the right atrium (RA), ventricle (RV) and atrioventricular (AV)...

     
    Area of Interest: Cardiac; Cardiovascular system; Vascular; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Aneurysms; Grafts;

    PV scan (sagittal image) confirming a large (7.5 x 6.4 x 10.2 cm) right coronary artery SVG graft aneurysm with localised anterior mass effect indenting the right atrium (RA), ventricle (RV) and atrioventricular (AV)...

     
    Area of Interest: Arteries / Aorta; Cardiac; Cardiovascular system; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Aneurysms; Grafts;
     
     
  • Figure 3
    Cardiac MRI

    Single-Shot, Black Blood (breath-hold) axial MR image demonstrating the aneurysmal saphenous graft as a mass adjacent to right heart border and compressing RA. No abnormal enhancement on delayed Gadolinium MR imaging....

     
    Area of Interest: Cardiac; Cardiovascular system; Vascular; Imaging Technique: MR; MR-Angiography; Procedure: Diagnostic procedure; Special Focus: Grafts;
     
     
A recent plain radiograph showing an unusual contour to the right side of the heart. Further assessment with cross-sectional imaging was recommended. Elsewhere the lungs are clear, previous median sternotomy noted.
 
An old chest radiograph (2 years before) showing the abnormality which was thought then to be a hiatus hernia. However, it has an exaggerated dense contour if compared with the subsequent recent image.
 
PV scan (axial image) confirming a large (7.5 x 6.4 x 10.2 cm) right coronary artery SVG aneurysm (arrow) with localised anterior mass effect indenting the right atrium (RA), ventricle (RV) and atrioventricular (AV) groove.
 
PV scan (coronal image) confirming a large (7.5 x 6.4 x 10.2 cm) right coronary artery SVG graft aneurysm with localised anterior mass effect indenting the right atrium (RA), ventricle (RV) and atrioventricular (AV) groove.
 
PV scan (sagittal image) confirming a large (7.5 x 6.4 x 10.2 cm) right coronary artery SVG graft aneurysm with localised anterior mass effect indenting the right atrium (RA), ventricle (RV) and atrioventricular (AV) groove.
 
Single-Shot, Black Blood (breath-hold) axial MR image demonstrating the aneurysmal saphenous graft as a mass adjacent to right heart border and compressing RA. No abnormal enhancement on delayed Gadolinium MR imaging. (TE:27.86ms/TR:2000ms)
 
 
 
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