Aortic prosthetic graft infections: Radiologic manifestations and implications for management

Prosthetic graft infections are an uncommon complication of aortic bypass. These infections may have serious sequelae such as limb loss and can be let hal. They are hard to eradicate and, under certain circumstances, difficult to diagnose. Usually, computed tomography (CT) is the most efficacious ima ging method for diagnosis of graft infections due to its quick availability . The sensitivity of magnetic resonance imaging in detection of perigraft i nfection has not been thoroughly investigated but is probably similar to th at of CT. After the early postoperative period, persistent or expanding per igraft soft tissue, fluid, and gas are the CT findings of graft infection. Aortoenteric fistula should be considered a subset of aortic graft infectio n; however, perigraft air is more likely to be seen with an aortoenteric fi stula. Other conditions associated with graft infection include pseudoaneur ysm, hydronephrosis, and osteomyelitis. Adjunctive studies such as sinograp hy, ultrasonography, gallium scanning, and labeled white blood cell scannin g can be quite useful in diagnosis, determination of the extent of disease, and selection of the treatment modality. White blood cell scanning is an i mportant complementary test to CT in ambiguous cases, such as in the early postoperative period, and may be more sensitive in detection of early graft infection.