presentation. The coronary artery bypass surgery had been an uncomplicated procedure, and the patient had been free of symptoms of coronary disease in the interim. The patient had recently undergone multiple diagnostic evaluations for investigation of lethargy and weight loss that had included CT of the thorax and abdomen. This examination had failed to reveal any cause for the symptoms. When the patient presented with signs and symptoms of superior vena cava obstruction, the previously obtained CT scan was reviewed to see whether a potential cause could be found. A pseudoaneurysm of the right coronary artery bypass vein graft was identified (Fig. 1A). This dilated vascular structure was deemed a pseudoaneurysm because of its proximity to the anastomosis of the vein graft and the right coronary artery. This finding had not been noted at the time of the previous examination. A repeat CT scan of the thorax showed a large ruptured pseudoaneurysm of the right coronary artery bypass vein graft with a hematoma that was compressing the right atrium and superior vena cava (Fig. 1B). Although an arterial phase CT scan was acquired, the ruptured pseudoaneurysm was more clearly defined on the delayed phase scan (Fig. 1C). The findings were consistent with the rupture of a pseudoaneurysm of the coronary artery bypass vein graft, resulting in acute superior vena cava obstruction. The patient developed a fatal arrhythmia while being transferred to the operating room for surgical repair, and subsequent resuscitation attempts were unsuccessful.