Ascending aorta pseudoaneurysm simulating mediastinal lymphoma in computed tomography, a possible diagnostic error: a ca
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(2020) 14:167
CASE REPORT
Open Access
Ascending aorta pseudoaneurysm simulating mediastinal lymphoma in computed tomography, a possible diagnostic error: a case report Marcello Chiocchi1, Luigi Spiritigliozzi1*, Federica Di Tosto1, Leonardo Benelli1, Francesca D’Errico1, Matteo Presicce1, Luca Pugliese1, Francesca Ricci1, Vincenzo De Stasio1, Carlo Di Donna1, Monia Pasqualetto1, Dionisio Ferdinando Colella2 and Roberto Floris1
Abstract Background: An ascending aortic pseudoaneurysm is a severe and rare complication following cardiothoracic surgery. This case report demonstrates its possible misinterpretation and the consequent importance of multidisciplinary evaluation. Case presentation: We present a case of an 18-year-old Caucasian man with Marfan syndrome who developed an ascending aortic pseudoaneurysm about 1 year after undergoing cardiac surgery with the Bentall procedure. Computed tomographic examination of the thoracic aorta and positron emission tomography–computed tomography initially suggested a lymphomatous pathology. However, these imaging results were in contrast to the transesophageal echocardiogram and the laboratory data that showed negative results for hematological pathology. A second computed tomographic scan redirected the diagnosis toward a pseudoaneurysm. Conclusion: This case demonstrates the utility of close communication and interdisciplinary consultation between cardiovascular radiologists and the cardiac surgery team, which are mandatory in order to maximize their diagnostic skills in identifying postoperative complications. Keywords: Aortic pseudoaneurysm, Marfan syndrome, Computed tomography, Transesophageal echocardiogram, Mediastinal lymphoma
Introduction An ascending aortic pseudoaneurysm (AAP) is a severe and rare complication following cardiothoracic surgery. Patients present with fever, chest pain, or mass effect, but it is also possible to find a pseudoaneurysm upon imaging evaluation in asymptomatic patients [1, 2]. Recent literature does not offer definitive guidelines for the * Correspondence: [email protected] 1 Department of Diagnostic Imaging and Interventional Radiology, Policlinico Tor Vergata, Rome, Italy Full list of author information is available at the end of the article
management of pseudoaneurysm, but surgical treatment is usually recommended in symptomatic as well as asymptomatic patients [3]. In this report, we present a case of an 18-year-old man with Marfan syndrome who developed AAP about 1 year after undergoing cardiac surgery with the Bentall procedure. Computed tomography of the thoracic aorta and positron emission tomography–computed tomography initially suggested lymphomatous pathology. However, the results of the above-mentioned techniques were in contrast to the transesophageal echocardiogram (TEE) and the
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