PMC9709172_01
Pseudoaneurysm (87 mm x 50 mm) at the distal anastomosis site: (a) axial view and (b) coronal view.
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Computed tomography (CT) revealed a pseudoaneurysm (diameter: 87 mm x 50 mm) at the distal anastomosis immediately adjacent to the right upper lung (Figure 1), which increased rapidly by 20 mm over the previous 2 years.
Blood in the lung parenchyma (pink; white arrow) communicated with the pseudoaneurysm (green; block arrow): (a) frontal view and (b) right side view.
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After 2 weeks, he suddenly developed desaturation with hemoptysis, indicating intrapulmonary perforation (Figures 2 and 3).
Pulmonary window setting: (a) coronal view and (b) axial view.
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After 2 weeks, he suddenly developed desaturation with hemoptysis, indicating intrapulmonary perforation (Figures 2 and 3).
(a) Perforated intima of the aortic posterior wall. (b) Fistula covered by the surrounding hematoma.
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For the pseudoaneurysm on the distal anastomosis, the intima of the aortic posterior wall was perforated halfway around (Figure 4(a)) and reinforced by a felt strip to the inner and outer sides using the inclusion technique. Regarding fistula detection, the apparent fistula was not recognized by the surrounding hematoma, and because of tissue fragility, radical debridement was not performed (Figure 4(b)).
Postoperative three-dimensional computed tomography.
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Tokyo, Japan) was performed (Figure 5). There were concerns regarding pulmonary hemorrhage from the injured lung after withdrawal from the cardiopulmonary bypass; however, bleeding was not observed. The ventilator was withdrawn on the same day and the patient did not exhibit any neurological complications.