Pulsatile To-and-Fro Flow Detected by Contrast-Enhanced Electrocardiogram-Gated Computed Tomography

A 64-year-old man came to the emergency department complaining of dyspnea. He had a history of ascending aortic pseudoaneurysm treated by ascending aortic and total arch replacement 2 months before. Because he had had deep vein thrombosis of the femoral vein, pulmonary thromboembolism was suspected, and contrast-enhanced computed tomography (CT) of the chest was performed. The dose-length product was 223 mGy · cm; the effective dose (3.12 mSv) was determined using the European Guidelines for Multislice Computed Tomography estimate for thorax effective dose per DLP of 0.014 mSv/(mGy*cm).1 On CT, a pseudoaneurysm was noticed at the anterosuperior mediastinum. The definite leak point was not identifiable, but the anastomotic site between the left common carotid artery and the aortic arch was suspected to be the leakage point (Figure 1). Because no leakage point was detected on conventional angiography, treatment with conservative management was chosen for the best of the patient.Figure 1. A pseudoaneurysm at the anterosuperior mediastinum. Suspected leakage site with focal loss of left common carotid …