NASCI case of the month: extensive ascending aortic graft infection with underlying chronic sternal osteomyelitis—a rare and high-risk complication

• Published in: The international journal of cardiovascular imaging 2024-07, Vol.40 (7), p.1609-1611
• Main Authors: Wieseler, Carissa, Young, Phillip M.
• Format: Article
• Language: English
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; Aorta; Aortography - methods; Blood Vessel Prosthesis - adverse effects; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blood vessels; Cardiac Imaging; Cardiology; Cardiovascular diseases; Chronic Disease; Chronic infection; Computed tomography; Diabetes mellitus; Fluorodeoxyglucose F18 - administration & dosage; Grafting; Health risks; Humans; Imaging; Male; Malnutrition; Medicine; Medicine & Public Health; Middle Aged; Osteomyelitis; Osteomyelitis - diagnostic imaging; Osteomyelitis - etiology; Osteomyelitis - surgery; Positron emission; Positron Emission Tomography Computed Tomography; Postoperative infection; Predictive Value of Tests; Prosthesis-Related Infections - diagnostic imaging; Prosthesis-Related Infections - etiology; Prosthesis-Related Infections - microbiology; Prosthesis-Related Infections - surgery; Radiology; Radiopharmaceuticals; Risk Factors; Soft tissues; Sternum - diagnostic imaging; Sternum - surgery; Thorax; Thrombosis; Treatment Outcome; Wound infection
• ISSN: 1875-8312; 1569-5794; 1875-8312; 1573-0743
• DOI: 10.1007/s10554-024-03117-8

Thoracic aortic graft infections are infrequent yet grave complications of cardiovascular surgery. Risk factors include prolonged operative time, postoperative wound infections, and patient-specific risk factors like diabetes or malnutrition (Van Hemelrijck et al., Vessel Plus 6:47, 2022). In postoperative vascular scenarios, it is critical to utilize cross-sectional imaging to detect the presence of a complication, followed by describing the morphology, extent, and ancillary features. FDG-PET/CT can help differentiate between expected postoperative changes and worrisome infection by metabolic activity (FDG uptake). We present an extensive case of ascending aortic graft infection in the setting of ongoing sternal osteomyelitis. CT and PET/CT reveal chronic sternal osteomyelitic changes spreading into the retrosternal soft tissues, and a large intraluminal thrombus in the ascending aortic graft. Small mobile strands propagate toward the right brachiocephalic origin, posing a significant stroke risk. PET/CT confirmed postoperative infection by demonstrating increased FDG uptake.