Gadofosveset-enhanced 4D magnetic resonance angiography as a means of localizing the site of post aortic graft leak

A 52-year-old male underwent simultaneous replacement of a severely stenotic bicuspid aortic valve with a CarboMedics 25-mm prosthesis and replacement of the aneurysmal ascending aorta with a Vascutek 28-mm graft. Follow-up CT angiographies of the thoracic aorta revealed a progressively enlarging pseudoaneurysm along the entire length of the ascending aorta. On the last scan, the pseudoaneurysm measured 122×98×174 mm. The site of the leak could not be identified on any of the postoperative scans (Fig. 1). MRI angiography of the thoracic aorta was performed next. Intravenous Gadofosveset-enhanced first-pass 4D Trak MR angiography allowed identification of the site of contrast leak into the pseudoaneurysm at the proximal anastomosis, appearing as a discreet, progressively enlarging area of progressively increasing intensity (Fig. 2).