Mediastinal mass presented 36 years after coronary bypass grafting: is vein graft pseudoaneurysm a differential...

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Diagnostic Imaging

Background:

• Saphenous vein graft aneurysm is a rare but serious complication following coronary artery bypass grafting (CABG).
• Diagnosis can be challenging, particularly with atypical or late presentations.
• Requires a high index of suspicion for accurate identification.

Observation:

• A case of saphenous vein graft pseudoaneurysm presented 36 years after CABG.
• The pseudoaneurysm mimicked a right atrial myxoma on serial echocardiograms.
• A 2-year follow-up period was used for serial echocardiographic monitoring.

Findings:

• The study reports a unique case of a late-presenting saphenous vein graft pseudoaneurysm.
• Echocardiography initially suggested a right atrial myxoma, complicating diagnosis.
• The true nature of the lesion was revealed after extensive follow-up.

Implications:

• This case underscores the importance of considering graft complications in patients with a history of CABG, even decades later.
• Atypical presentations of saphenous vein graft aneurysms can mimic other cardiac pathologies.
• Enhanced vigilance and advanced imaging may be necessary for diagnosing rare post-CABG complications.