Ruptured right coronary artery bypass graft aneurysm causing haemothorax

A woman in her 80s with a background of a coronary artery bypass graft (CABG) presented with chest pain. Initial investigations revealed an elevated D-dimer, normocytic anaemia and right-sided pleural effusion. CT pulmonary angiogram ruled out a pulmonary embolism but revealed an incidental cyst-like rounded lesion next to the ascending aorta. A triphasic CT of the chest confirmed this to be an aneurysm arising from the right coronary artery bypass vein graft, measuring 5.4 cm. After the multidisciplinary team meeting discussion, the likely diagnosis was thought to be a ruptured aneurysm, leading to a haematoma formation and right-sided haemothorax. Conservative management was chosen following multidisciplinary discussion and shared decision-making with the patient and family, and patient unfortunately did not survive admission. This case highlights rare and life-threatening complication of vein graft aneurysms and the importance of early recognition and individualised management plans.