A 68-year-old man suffering from ischaemic cardiomyopathy with a decreased left ventricular ejection fraction (22%) presented with a fourth pulmonary oedema in two years. Nineteen years earlier, he had had symptomatic myocardial ischaemia and underwent coronary artery bypass graft (CABG) surgery consisting of four saphenous vein grafts (SVGs). After presentation, chest X-ray revealed a voluminous mass in the left lung hidden by a pacemaker ( Fig. 1 A and B ) that was not detected on chest X-ray performed one year earlier ( Fig. 1 C). A vascular mass was suspected on echocardiography; however, it was not possible to identify whether this mass was appended to a vascular structure or a cardiac cavity. Subsequent computed tomography (CT) imaging indicated that the mass was a voluminous pseudoaneurysm of the SVG connecting the aorta to the posterolateral branch of the circumflex coronary artery ( Fig. 2 A ); the saccular pseudoaneurysm had developed at the distal anastomotic site and there was no fistula ( Fig. 2 B).
