Right pulmonary artery obstruction due to anastomotic pseudo-aneurysm 23 years after implantation of an aortic prosthesis.

Fig. 1. Preoperative images. (a) Chest X-ray. (b) Pulmonary scan with Tc-99mMAA shows absence of right lung perfusion. (c) CT image with intravenous contrast shows obstructed right pulmonary artery due to pseudo-aneurysm behind a prosthetic graft that had been implanted 23 years earlier for acute aortic dissection. These findings were accompanied by elevated D-dimer (38.2 mcg dl ) and dyspnoea over a period of 2 years that had rapidly deteriorated over the past month, followed by sudden pain in the right chest. Emergency surgery was thus required to recover right lung perfusion. Clinical and radiological signs of infection were absent.