0:00

In this next scan, we're going to look at post-surgical changes that might happen

0:04

once a patient undergoes a bypass graft surgery, and what might

0:08

be the common imaging appearance.

0:10

So again, this is one setting where I think having a non-contrast is really

0:14

helpful. As I'm scrolling down, you're going to see that

0:18

there is a drain in this left inguinal region and a large collection

0:22

in this inguinal region. Scrolling through the arterial phase

0:26

and going all the way down to the left inguinal region,

0:30

you can see that this patient has an

0:33

aortofemoral bypass graft. So this is the

0:37

aorta right here, and then at the back,

0:42

that's the native bilateral

0:45

common iliac arteries that are occluded, and those are the occluded

0:48

vessels right at the back. There's a stent in that native

0:52

external iliac artery right there.

0:55

And really in front of it is where that bypass graft lies.

0:57

So you have that aortofemoral

1:02

bypass graft, and this is the level of the anastomosis right here

1:06

as well as right here.

1:09

And having an I-minus and an arterial phase really helps

1:13

us problem solve. So there isn't much of an outpouching that

1:17

we see at that anastomosis that would suggest a

1:19

pseudoaneurysm. We're going to have to make sure

1:23

that none of this is an active bleed.

1:25

So having this non-contrast is really helpful in that knowing that all of

1:28

this was bright already before giving contrast means that this is

1:33

not an active bleed.

1:36

And then looking at all of these hyperdensities and making

1:40

sure that they're also there on your non-contrast scan is extremely

1:44

helpful as well.

1:47

And so all this person really had is a hematoma at

1:50

their bypass graft anastomosis, but no

1:54

pseudoaneurysm, no active extravasation,

1:58

no dehiscence as such. And

2:03

another more common collection that you might see in relation

2:07

to a bypass graft is just a simple fluid collection without enhancement.

2:11

Something that is not hyperdense, unlike this one, which measures 39 Hounsfield

2:15

unit when it's suggestive of a hematoma.

2:19

You can just have a simple fluid seroma at that

2:22

site.