A36-year-old man was referred to our echocardiography department for follow-up echocardiography. He had undergone the Bentall operation 8 months previously because of an aneurysmal dilation of the ascending aorta (59 mm). His clinical history and physical examinations were unremarkable. Transthoracic echocardiography revealed a round, well-defined mass (35 mm × 32 mm) on the left side of the aortic tube graft in the modified parasternal short-axis view at the level of the aorta [ and ]. The other echocardiographic findings included preserved systolic left ventricular function (ejection fraction = 50%), mild right ventricular dysfunction, up-to-moderate mitral regurgitation, mild tricuspid regurgitation, and a normally functioning bileaflet mechanical aortic valve. Computed tomography (CT) angiography of the aorta showed a well-defined hematoma in the mid-mediastinal space below the pulmonary artery []. The left main coronary site implantation and the distal anastomosis site of the aortic tube graft were intact, and no connection was seen between the aortic tube graft and this hematoma. Because this hematoma produced no compressive symptoms and signs, the heart team decided to follow-up the patient.
A 73-year-old woman presented with angina CCS class I. Her past medical history included hypertension, obesity, and an apoplectic event. Electrocardiography did not show any repolarization disturbances, whereas stress echocardiography demonstrated a significant area of inducible myocardial ischemia. Due to these findings and typical symptoms, a diagnostic heart catheterization was performed via the radial artery. A standard dose of 5.000 IE heparin was given. During the procedure the insertion of the polymer-jacketed guidewire was technically difficult probably due to the narrowness of the chosen vessel. The patient complained of back pain. A computed tomography (CT) scan demonstrated a perforation of the right subclavian artery with a mediastinal hematoma (), and the patient was referred to the Department of Vascular Surgery for further treatment. Initially, it was decided to treat the finding with a stent. However, during the vascular interventional procedure the leak could not be detected and the procedure was aborted. In a subsequent CT scan the leak was no longer verifiable. Finally, after further conservative treatment the patient was returned to the referring hospital where she was successfully stented via transfemoral PCI. One year later, a follow-up CT scan did not show any abnormalities.