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Case Reports
. 2008 Dec 16:3:64.
doi: 10.1186/1749-8090-3-64.

Septic rupture of the ascending aorta after aortocoronary bypass surgery

Christof M Sommer  1 , Tobias Heye, Ulrike Stampfl, Ursula Tochtermann, Boris A Radeleff, Hans U Kauczor, Goetz M Richter
Affiliations
Case Reports

Septic rupture of the ascending aorta after aortocoronary bypass surgery

Christof M Sommer et al. J Cardiothorac Surg. .

Abstract

We describe an exceptional case of non-fatal septic rupture of the ascending aorta in a patient with sternal dehiscence, deep sternal wound infection (DSWI) and pleural empyema after aortocoronary bypass surgery. Routine follow-up computed tomography (CT) detected a mediastinal pseudoaneurysm originating from the ascending aorta. Thereby, massive and irregular sternal bone defects and contrast-enhancing mediastinal soft tissue suggest osteomyelitis and highly-active and aggressive DSWI as initial triggers. Urgent thoracotomy 1 day later included ascending aorta reconstruction, total sternum resection and broad wound debridement. Follow-up CT 1 year later showed a regular postoperative result in a fully recovered patient.

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Figures

Figure 1
Figure 1
Sternum osteomyelitis. CT 3D-reconstruction shows massive sternal bone defects, inhomogenous bone matrix and irregular sternotomy edges (white arrows) as evidence for long-lasting chronic osteomyelitis
Figure 2
Figure 2
DSWI with pseudoaneurysm. CT axial (A) and sagittal (B) reconstructions show clearly contrast-enhancing soft tissue in the upper and anterior mediastinum (areas encirceled by white lines); ascending aorta (Ao), pseudoaneurysm (asterisk), left ventricle (LV) and massive sternal bone defects (white arrows).
See this image and copyright information in PMC

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