Single photon emission computed tomography radionuclide ventriculography in the noninvasive diagnosis and evaluation of a false left ventricular aneurysm (pseudoaneurysm)

Left ventricular pseudoaneurysm after myocardial infarction detected by cardiac MRI

Left ventricular free wall rupture (LVFWR) is a grave complication of acute myocardial infarction. Acutely, it has an extremely high rate of mortality, especially if undetected. Chronically, there is paucity of data on how to manage the pathology, especially if detected as an incidental finding. We present a unique case of initially undetected LVFWR in a patient who presented with repeated chest pain. Cardiac MRI enabled the diagnosis and localisation of the original site of LVFWR and provided highly relevant volume calculations. Measurement of both absolute and virtual volumes indicated that aneurysm resection, including the original site of rupture, was surgically feasible without reducing postoperative stroke volume.

Unruptured giant left ventricular pseudoaneurysm complicating silent myocardial infarction in a diabetic young adult

We report a very rare case of a 36-year-old diabetic man who had a silent myocardial infarction, a ruptured myocardial wall, and an unruptured left ventricular pseudoaneurysm. The patient admitted with a 3-month history of dyspnea on exertion, without evidence of acute coronary syndrome. Coronary angiography showed severe stenosis of the right coronary artery. Echocardiography, multiple gated acquisition radionuclide scan (MUGA) and left ventricular angiography revealed giant left ventricular posterolateral pseudoaneurysm next to the left ventricle. Patient underwent to surgery with excellent results. We present this case because rarity and high clinical index of suspicion is needed to avoid missing the diagnosis in such an unusual sequence of silent myocardial infarction in diabetic patient. The clinical picture of dyspnea in a diabetic patient in presence of a diagnostic echocardiographic finding warrants coronary angiography to document the ischemic etiology of the pseudoaneurysm in view of prompt surgical correction.