Left ventricular pseudoaneurysm: An unexpected finding

Cardiac MRI in the diagnosis and management of left ventricular pseudoaneurysms with previous myocardial infarction: A report of two cases

A left ventricular pseudoaneurysm, an ominous consequence of acute myocardial infarction, poses a significant threat to patient well-being. Prompt and accurate diagnosis is crucial for improving patient outcomes. This report describes diagnostic imaging findings for identifying left ventricular pseudoaneurysms, emphasizing the critical role of cardiac magnetic resonance imaging alongside other modalities. We present two cases of patients with a history of myocardial infarction who presented with palpitations, chest pain, and shortness of breath. Initial 2D echocardiography in both patients revealed aneurysmal dilation of the left ventricle. Cardiac MRI was then performed, confirming the diagnosis in both cases.

Case Report: A left ventricular pseudoaneurysm detected by cardiac magnetic resonance more than 1 year after a percutaneous transluminal coronary intervention

Pseudoaneurysm is a rare but lethal complication of acute myocardial infarction. In this study, we present a unique case of a patient with left ventricular free wall rupture detected by cardiac magnetic resonance more than 1 year after a percutaneous transluminal coronary intervention.

Cardiac Outpouchings: Definitions, Differential Diagnosis, and Therapeutic Approach

Background and Aims

Cardiac outpouchings encounter a series of distinct congenital or acquired entities (i.e. aneurysms, pseudoaneurysms, diverticula, and herniations), whose knowledge is still poorly widespread in clinical practice. This review aims to provide a comprehensive overview focusing on definition, differential diagnosis, and prognostic outcomes of cardiac outpouchings, as well as further insights on therapeutic options, in order to assist physicians in the most appropriate decision-making.

Methods

The material reviewed was obtained by the following search engines: MEDLINE (PubMed), EMBASE, Google Scholar, and Clinical Trials databases, from January 1966 until March 2021. We searched for the following keywords (in title and/or abstract): (“cardiac” OR “heart”) AND (“outpouching” OR “outpouch” OR “aneurysm” OR “pseudoaneurysm” OR “false aneurysm” OR “diverticulum” OR “herniation”). Review articles, original articles, case series, and case reports with literature review were included in our search. Data from patients with congenital or acquired cardiac outpouchings, from prenatal to geriatric age range, were investigated.

Results

Out of the 378 papers initially retrieved, 165 duplicates and 84 records in languages other than English were removed. Among the 129 remaining articles, 76 were included in our research material, on the basis of the following inclusion criteria: (a) papers pertaining to the research topic; (b) peer-reviewed articles; (c) using standardized diagnostic criteria; and (d) reporting raw prevalence data. Location, morphologic features, wall motion abnormalities, and tissue characterization were found to have a significant impact in recognition and differential diagnosis of cardiac outpouchings as well as to play a significant role in defining their natural history and prognostic outcomes.

Conclusions

Careful recognition of cardiac outpouchings remains a diagnostic challenge in clinical practice. Due to a broad cluster of distinctive and heterogeneous entities, their knowledge and timely recognition play a pivotal role in order to provide the most appropriate clinical management and therapeutic approach.

A case of a giant left ventricular pseudoaneurysm

A Left ventricular pseudoaneurysm is an outpouching resulting from myocardial free wall rupture which is contained by an adherent pericardium or scar tissue. It most often occurs after transmural myocardial infarction, but may also follow cardiac operations, trauma, inflammation, or infection. In contrast to patients with true ventricular aneurysms, those with false aneurysms most commonly die of hemorrhage. Transthoracic echocardiogram, computed tomography scan and cardiac MRI are currently the noninvasive modalities, whereas coronary arteriography and left ventriculography are invasive modalities used for diagnosis. As this condition is lethal, prompt diagnosis and timely management are vital. We present a case report of a patient with no prior risk factors who presented for 1 year with palpitations during exercise and rest, as well as intermittent chest pain. A transthoracic echocardiogram was performed. Echocardiogram revealed an unexpected outpouching of the left ventricle. A computed tomography scan confirmed the diagnosis by revealing a massive left ventricule pseudomanoeuvre. The patient was offered surgery, but he refused the procedure due to the surgical risk.