Non-Woven Haemostatic Agent Mimicking Perigraft Abscess Following Thoracic Aortic Surgery

Background and Clinical Significance: Absorbable haemostatic agents such as Surgicel^® Fibrillar are useful adjuncts to control post-surgical bleeding in cardiac surgery. The material is purposefully left in situ and it slowly degrades over time. Previous publications, mainly in general and gynaecological surgery, have demonstrated that these materials can mimic gangrenous infection, abscesses, anastomotic leak, and early tumour recurrence in imaging studies. These findings can often lead to unnecessary re-interventions or re-operations. The number of reports in the cardiothoracic surgical field is limited. Case Presentation: We report a 45-year-old man who underwent aortic valve replacement and ascending aorta and hemiarch replacement. In this case, Surgicel^® Fibrillar was used to optimise graft contouring, contributing to postoperative imaging appearances that initially raised concern for infection. The patient was conservatively managed given his stable clinical picture and focused review of CT images with the knowledge of location of Surgicel^® Fibrillar. Repeat CT scan after 2 weeks showed a significant reduction in collection size and complete resolution of air bubbles within the collection. Conclusions: It is important for cardiothoracic surgeons and radiologists to be aware of the early CT appearances of haemostatic agents to minimise erroneous diagnosis of postoperative complications leading to unnecessary interventions. This case highlights a diagnostic pitfall in postoperative imaging, where retained absorbable haemostatic material may mimic serious infective complications and lead to unnecessary re-intervention if operative and radiological findings are not carefully correlated.