Chest Pain Following Aortocoronary Bypass Graft

History A 48-year-old man underwent three-vessel aortocoronary bypass graft for unstable angina and high-grade occlusive coronary artery disease. Postoperatively, the patient did well and had total relief of pain. Use of all cardiac medication was discontinued. He was discharged after ten days. Four weeks later he was readmitted to the hospital with recurrent chest pain. Physical examination revealed low-grade fever, with temperature of 38 °C. The lungs were clear and cardiovascular examination results were normal. An ECG demonstrated minor diffuse ST-T wave changes. Serial creatinine phosphokinase (MB isoenzymes) and SGOT measurements were within nomal levels. A computed tomogram (CT) of the chest (Fig 1) was obtained. Diagnosis Postpericardiotomy syndrome with patent aortocoronary bypass grafts. Figure 2 shows a CT section taken at the level of the aortocoronary bypass grafts after infusion of contrast material. Patent grafts to the right, left anterior descending, and circumflex coronary arteries are clearly seen as