A 59-year-old female with a past medical history of tobacco abuse, hypertension, and coronary artery disease and prior percutaneous coronary intervention presented with complaints of angina and subsequently underwent coronary angiography. The procedure was performed via the right radial artery approach. A 5 French Jacky catheter was used to engage the left coronary artery system, and a 6 French Judkins Right 4 catheter was used to engage the right coronary artery system. The procedure was completed without difficulty from the operator, and the patient was transferred to the postoperative holding area in stable condition.\nHowever, immediately after the procedure, the patient began to experience chest pain and odynophagia. Stat electrocardiogram and bedside echocardiogram were unremarkable, and a CT scan demonstrated an ill-defined fluid collection present in the superior mediastinum ().\nWhile a hematoma and a mass were both considered to be in the differential diagnosis, the CT scan also made note of an aberrant right subclavian artery (ARSA) coursing posterior to the trachea and esophagus (). Esophageal anomalies were otherwise ruled out with an esophagram, and the differential diagnosis was narrowed down to a mediastinal hematoma.\nConsequently, the patient was admitted to the cardiac care unit but continued to complain of midsternal chest pain and odynophagia. The patient remained hemodynamically stable and without any airway compromise. The patient was managed expectantly with analgesia. A repeat CT scan a day later again demonstrated the ill-defined collection which had now extended into the inferior right paravertebral aspect near the gastroesophageal junction. This was deemed to be an extension of the same fluid collection with the size of the hematoma remaining stable. The patient was monitored closely and improved clinically over the course of four days and was subsequently discharged home in good condition. On outpatient follow-up, the patient reported her symptoms had completely resolved.
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.