Granulomatous inflammation mimicking a hematoma around the replaced ascending aorta in magnetic resonance imaging: a case report

• Published in: Journal of cardiothoracic surgery 2023-06, Vol.18 (1), p.191-191, Article 191
• Main Authors: Lee, June, Lim, Hyun Ah, Hong, Seok Beom, Kim, Do Yeon, Kim, Yong Han, Kim, Hwan Wook
• Format: Article
• Language: English
• Subjects: Abscesses; Allergic reaction; Allergic reactions; Allergy; Aorta; Cardiology; Case Report; Case reports; Chest; Computed tomography; Coronary vessels; CT imaging; Disease; Dissection; Granulomatous inflammation; Health aspects; Heart surgery; Hematoma; Hypersensitivity; Infection; Infections; Inflammation; Magnetic resonance imaging; Medical imaging; Mortality; Patients; Polymerase chain reaction; Pseudoaneurysm; Radiology; Sarcoidosis; Thoracic aortic surgery; Thoracic surgery; Thorax; Tomography; Trauma; Tuberculosis
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-023-02298-y

Granulomatous inflammation results from various causes including infections and allergic reactions. It can appear as high signal intensity in T2-weighted or contrast-enhanced T1-weighted magnetic resonance imaging (MRI). Here, we describe a case of granulomatous inflammation looking like a hematoma on an ascending aortic graft in MRI. A 75-year-old female was undergoing assessment for chest pain. She had a history of hemi-arch replacement for aortic dissection 10 years earlier. The initial chest computed tomography and subsequent chest MRI were suggestive of a hematoma, implying a pseudoaneurysm of the thoracic aorta, which is associated with high mortality in reoperation. Through redo median sternotomy, severe adhesion was found in the retrosternal space. A sac in the pericardial space contained yellowish and pus-like material, confirming that there was no hematoma around the ascending aortic graft. The pathologic finding was chronic necrotizing granulomatous inflammation. Microbiological tests including polymerase chain reaction analysis were negative. Our experience indicates that an MRI finding of a hematoma at the site long after cardiovascular surgery suggests that there may be granulomatous inflammation.