Cardiac tamponade caused by a leaking coronary saphenous vein graft aneurysm

The presumed diagnosis of inferior wall myocardial infarction with cardiogenic shock was made, and the patient was taken emergently to the cardiac catheterization laboratory. Because of the widened mediastinum, the possibility of an aortic dissection was an initial concern; however, his aorta appeared normal by angiogram. Patient was then emergently taken to the computed tomography scanner and the diagnosis of ruptured vein graft aneurysm was made (Fig. 1). Because of the tamponade physiology and inability to percutaneously intervene, surgical consultation was requested.