Cardiac Outpouchings: Definitions, Differential Diagnosis, and Therapeutic Approach

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.

Unusual cardiac aneurysms: a surgical pathology experience

Among the cardiac outpouchings, left ventricular aneurysms or pseudo-aneurysms that develop secondary to myocardial infarctions are the most common. On the other hand, atrial appendageal and valvular aneurysms are uncommon occurrences. The appendageal aneurysms develop possibly due to congenital dysplasia of atrial pectinate muscles, while valvular aneurysms result from infective endocarditis, mechanical injury or degenerative changes. Despite their unusual locations, they are prone to life-threatening complications. We present our experience of unusual cardiac aneurysms in surgical cardiovascular material.

Left Ventricular Pseudoaneurysm in an Adult With a Repaired Partial Atrioventricular Canal Defect

•LV pseudoaneurysm formation is rare after congenital heart disease repair. •Conservative management of LV pseudoaneurysm was successful in this unique case. •CCT and 3D printing are valuable in the characterization of LV pseudoaneurysm.

Multimodality Imaging of an Idiopathic Left Ventricular Aneurysm Presenting With Frequent Premature Ventricular Beats

•Apical outpouching in the LV may be due to an aneurysm or pseudoaneurysm. •Multimodality imaging is useful for the evaluation of LV outpouching. •An idiopathic LV aneurysm is a rare condition and is a diagnosis of exclusion. •Asymptomatic small LV aneurysm can be treated conservatively.

Hypertrophic cardiomyopathy - phenotypic variations beyond wall thickness

Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy (LVH) in the absence of another causal disease. Several morphologic and histologic changes have been described. Given the morbidity and mortality associated with HCM, understanding these anatomic variations is key to interpreting imaging. This is especially important since many patients exhibit these associated findings in the absence of LVH and prompt early detection of these variations may lead to early diagnosis and treatment. This article describes the appearance of morphologic variations seen in HCM beyond myocardial thickening including: papillary muscle and mitral valve variants, myocardial crypts, left ventricular myocardial bands, and dystrophic calcification related to increased wall tension.

Isolated muscular ventricular diverticulum assessment using multi-parameter echocardiographic imaging: Case reports

Ventricular diverticulum (VDi) is a rare and often asymptomatic congenital cardiac malformation detected incidentally as an outpouching on routine imaging examination, of which the muscular type has been less reported. Here, two patients were incidentally found to have outpouchings of the ventricle during routine transthoracic echocardiography. After a series of multi-parameter echocardiography examination, including two-dimensional (2D), three-dimensional (3D) photo-realistic rendering, blood speckle tracking (BST), and contrast enhancement, to provide morphological structure, spatial relationship, and blood flow information, both cases were finally diagnosed with muscular VDi. These cases highlight the advantages of using multi-parameter echocardiography for the comprehensive assessment of muscular VDi.

Cross-sectional imaging findings of cardiac outpouchings

A cardiac outpouching (CO) is a protrusion in a heart chamber's internal anatomical lining. Most COs are clinically insignificant, but some are of vital importance, requiring immediate surgery. Cross-sectional imaging findings of COs, such as location, morphology, size, and accompanying wall motion abnormalities, play an essential role in determining the correct diagnosis and appropriate clinical management. Therefore, radiologists should be familiar with them. This article reviews the key cross-sectional imaging findings and differential diagnoses of COs.

Cardiac contusions in the acute care setting: Historical background, evaluation and management

INTRODUCTION

Albeit described since 1763, cardiac contusions is still an under-recognised clinical condition in the acute care setting. This evidence-based review aims to provide an overview of the topic by focusing on etiopathogenesis, classification and clinical presentation of patients with cardiac contusions, as well as on the diagnostic work-up and therapy options available for this subset population in the acute care setting.

METHODS

A targeted research strategy was performed using PubMed, MEDLINE, Embase and Cochrane Central databases up to June 2022. The literature search was conducted using the following keywords (in Title and/or Abstract): ("cardiac" OR "heart" OR "myocardial") AND ("contusion"). All available high-quality resources written in English and containing information on epidemiology, etiopathogenesis, clinical findings, diagnosis and management of cardiac contusions were included in our research.

RESULTS

Biochemical samples of cardiac troponins together with a 12‑lead ECG appear to be sufficient screening tools in hemodynamically stable subjects, while cardiac ultrasound provides a further diagnostic clue for patients with hemodynamic instability or those more likely to have a significant cardiac contusion.

CONCLUSIONS

The management of patients with suspected cardiac contusion remains a challenge in clinical practice. For this kind of patients a comprehensive diagnostic approach and a prompt emergency response are required, taking into consideration the degree of severity and clinical impairment of associated traumatic injuries.

Dilated left ventricle with multiple outpouchings — a severe congenital ventricular diverticulum or left-dominant arrhythmogenic cardiomyopathy: A case report

BACKGROUND

Left-dominant arrhythmogenic cardiomyopathy (LDAC) is a relatively rare disease characterized by poor prognosis that exacerbates the incidence of sudden cardiac death and ventricular arrhythmias. Clinically, LDAC is constantly overlooked or misdiagnosed as myocardial infarction, myocarditis, and dilated cardiomyopathy, owing to atypical and nonspecific clinical manifestations at an early stage.

CASE SUMMARY

A 57-year-old woman was diagnosed with sinus bradycardia and chronic bifascicular block during a health check. She occasionally experienced mild chest pain and paroxysmal palpitation during activity in the past 2 years. Comprehensive auxiliary examinations, including electrocardiogram, echocardiography, coronary computerized tomography angiography, and magnetic resonance imaging, revealed that she had LDAC instead of congenital ventricular diverticulum. The physicians prescribed standard oral therapy for heart failure and implantable cardioverter-defibrillator. Consequently, her left ventricular systolic function and symptoms remained stable at the 2-year follow-up after discharge.

CONCLUSION

Based on this case, clinicians need to be aware of LDAC in patients with localized left ventricular lesions and multiple electrocardiographic abnormalities. Multimodality cardiovascular imaging is effective in identification of multiple types of cardiomyopathy and cardiac inner structures.