Diagnosing left ventricular aneurysm from pseudo-aneurysm: a case report and a review in literature

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.

Left ventricular pseudoaneurysm as a complication of LVAD explant

Left ventricular (LV) pseudoaneurysms are a rare disease entity associated with a multitude of etiologies. We describe the radiographic findings of an LV pseudoaneurysm arising as a complication of a leaking left ventricular assist device (LVAD) closure device. Computed tomographic angiography (CTA) imaging demonstrated an apical LV wall defect with a preperitoneal collection of extravasated contrast. A review of the patient's surgical history revealed prior LVAD placement and explant with placement of an LV closure device. Familiarity with the radiologic manifestation of LV pseudoaneurysms is critical to establish a prompt diagnosis and facilitate timely therapeutic intervention.

Contained Left Ventricular Free Wall Rupture Following a Silent Myocardial Infarction

A left ventricular pseudoaneurysm (LVP) is defined as an outpouching contained by the surrounding pericardium. Clinical presentation is often unspecific with patients presenting with chest pain, dyspnea, symptoms consistent with heart failure, and post-myocardial infarction. Cardiac magnetic resonance imaging represents an important tool for differentiating a pseudoaneurysm from a true aneurysm. Furthermore, multiple imagining modalities are available, including transesophageal and transthoracic echocardiogram and contrast ventriculography, which remains the gold standard diagnostic technique. Early recognition and prompt surgical management are of utmost importance in patients with acute and symptomatic LVP. On the other hand, medical management may be considered in patients with chronic and small pseudoaneurysms. Here, we are presenting a 74-year-old lady who presented with chest pain and was found to have a chronic and small LVP which was managed conservatively.

A rare case of a right ventricular Pseudo-aneurysm, related to an attempted suicide

We present the case of a 74-year-old female who attempted suicide by stabbing repeatedly with a nail scissor in the sub-sternal chest. Chest Computed Tomography (CT) performed at her arrival at our emergency department detected the presence of massive pericardial effusion. A follow-up cardiac CT after the pericardial drainage showed a Pseudo-aneurysm of the anterior wall of the right ventricle. <Learning objective: The evidence of post-traumatic right ventricular pseudo-aneurysm is a rare finding. Due to the challenge of diagnosis and potential fatality of this rare condition, it is important to be aware of its occurrence and to refine its recognition with imaging examinations.>.

Submitral aneurysm: An unusual localization of aneurysm complicating a myocardial infarction: A case report

Introduction

and importance: Submitral aneurysms are an uncommon heart condition that is widespread among young black Africans, congenital etiology is the most common, when SMA is found in patients of other races, other etiologies must be sought, especially ischemic.

Case presentation

We present the case of a 65-year-old male patient admitted for wide complex tachycardia at a rate of 198 bpm, in whom transthoracic echocardiography revealed a submitral aneurysm and coronary angiography revealed an occlusion of the left circumflex artery.

Clinical discussion

Submitral left ventricular aneurysm is a rare cardiac pathology with a variety of causes including inflammation, infection, traumatic illness, or, in rare cases, ischemic heart disease; it can be caused by a congenital defect in the posterior portion of the mitral annulus, which is more common in African population. Clinical manifestations are frequently serious and alarming, such as ventricular tachycardia, cardiogenic shock or an embolic phenomenon; however, asymptomatic cases are possible.

Conclusion

What we can retain from our case is that SMA can be the cause or consequence of coronary ischemia, so we must be vigilant in patients with an atypical clinical presentation.

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Submitral aneurysms are a rare cardiac abnormality

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They are more common in young black Africans

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Congenital etiology is the most implicated but when they are found in other races, other possible etiologies must be researched.

Incidental Discovery of a Left Ventricular Aneurysm After a Syncopal Episode

A left ventricular aneurysm is a rare post myocardial infarction complication. Ventricular aneurysms form as post-ischemic cardiac remodeling creates a weaker, fibrotic area that may bulge outwards against interventricular pressures over time. Patients with ventricular aneurysms have increased mortality and are at higher risk of various cardiac complications, such as cardiac arrest, arrhythmias, thrombus formation, reduced cardiac output, or aneurysmal rupture. Prompt diagnosis and treatment are critically important in these patients. We highlight the hospital course of a patient with an extensive cardiac history presenting for syncope with the discovery of a left ventricular aneurysm. The radiographic features of the left ventricular aneurysm are described, as well as formation, risk factors, and complications.

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.

Thrombosed left ventricular pseudoaneurysm following myocardial infarction: a case report

BACKGROUND

Pseudoaneurysm of inferior wall of the left ventricle is an uncommon complication of myocardial infarction with high mortality.

CASE PRESENTATION

We report the case of a 63-year-old Tunisian man, diagnosed with a thrombosed left ventricular pseudoaneurysm and a pericardial effusion after 1 week of angina.

CONCLUSIONS

Left ventricular pseudoaneurysm is a serious complication of myocardial infarction that has atypical presentations. Diagnosis is generally established by transthoracic echocardiography but confirmed by magnetic resonance imaging. Urgent surgery is the treatment choice given the risk of embolization and rupture.

Surgical Treatment of Chronic Giant Left Ventricular Pseudoaneurysm

Left ventricle pseudoaneurysm is usually a severe complication of acute myocardial infarction, caused by rupture of the myocardial wall with pericardium bleeding. Mortality can reach 50 to 80% within a week if not properly treated. Hemodynamic instability, cardiac tamponade, and cardiac arrest are life-threatening presentations that require surgical treatment. We report a case of a man with a left ventricle chronic giant pseudoaneurysm and unspecific symptoms. After critical judgement on a heart team basis, surgical treatment was successfully performed, with a good long-term clinical outcome.

A giant calcified aneurysm of the basal inferior wall: a rare phenomenon

Left ventricular aneurysms (LVA) are mainly a late consequence of transmural myocardial infarction. Approximately 80% of LVA are located in the anterior and/or apical walls, most commonly associated with left anterior descending artery occlusion but any region may be engaged. Basal inferior wall aneurysms are rare and constitute nearly 3% of all LVA. A calcified LVA is seldom observed in modern clinical practice. And a calcified basal inferior LVA is an even rarer coincidence. We report a case of an 82-year-old women with life threatening arrhythmia revealing a giant calcified aneurysm of the basal inferior wall, medically treated with good outcomes. The exact incidence of left ventricular aneurysms (LVA) following myocardial infarctions is hard to precise but it is clearly decreasing. Eighty percent (80%) of LVA are located in the anterior or apical walls, but any region may be engaged. Basal inferior wall aneurysms constitute 3% of all LVA. Echocardiography is the first diagnostic tool and there is still no clear guidelines on how to treat LVAs. Surgery is preferred but medical treatment may help improve the quality of life.

An Unpleasant Surprise: Left Ventricular Pseudoaneurysm Developing After Placement in Trendelenburg Position

Free wall rupture after a myocardial infarction may rarely cause a left ventricular (LV) pseudoaneurysm to develop. LV pseudoaneurysms are most commonly discovered incidentally on echocardiography and require a high index of suspicion to diagnose. We report the case of a 73-year-old male who experienced an asymptomatic myocardial infarction leading to cardiac arrest after placement in the Trendelenburg position. During resuscitation efforts, he was discovered to have an LV pseudoaneurysm on transthoracic echocardiogram. We report an unusual presentation of LV pseudoaneurysm and discuss a possible link between Trendelenburg position and the development of LV pseudoaneurysm.

Left Ventricular Aneurysm in a Child After Recovering From Dilated Cardiomyopathy

Left ventricular aneurysms are extremely rare in children. A child developed an aneurysm a year after recovering from idiopathic dilated cardiomyopathy. The initial management was conservative. After several years and due to aneurysm enlargement and other complications, the patient underwent successful aneurysm surgical repair with left ventricular aneurysmorrhaphy. We describe our experience treating this child during the course of this disease.

Unconventional Surgical Intervention for Left Ventricular Pseudoaneurysm Associated With Staphylococcus aureus in a Pediatric Patient

Ventricular pseudoaneurysms are very unusual in children. A six-year-old child developed left ventricular pseudoaneurysm associated with methicillin-sensitive Staphylococcus aureus. The patient responded favorably to antibiotic therapy and ventriculoplasty through an unconventional surgery due to the constrictive pericarditis.

Low Rank and Sparse Decomposition of Ultrasound Color Flow Images for Suppressing Clutter in Real-Time

In this work, a novel technique for real-time clutter rejection in ultrasound Color Flow Imaging (CFI) is proposed. Suppressing undesired clutter signal is important because clutter prohibits an unambiguous view of the vascular network. Although conventional eigen-based filters are potentially efficient in suppressing clutter signal, their performance is highly dependent on proper selection of a clutter to blood boundary which is done manually. Herein, we resolve this limitation by formulating the clutter suppression problem as a foreground-background separation problem to extract the moving blood component. To that end, we adapt the fast Robust Matrix Completion (fRMC) algorithm, and utilize the in-face extended Frank-Wolfe method to minimize the rank of the matrix of ultrasound frames. Our method automates the clutter suppression process, which is critical for clinical use. We name the method RAPID (Robust mAtrix decomPosition for suppressIng clutter in ultrasounD) since the automation step can substantially streamline clutter suppression. The technique is validated with simulation, flow phantom and two sets of in-vivo data. RAPID code as well as most of the data in this paper can be downloaded from RAPID.sonography.ai.

Acute respiratory distress secondary to a huge chronic left ventricular pseudo-aneurysm

Pseudo-aneurysms are a rare, potentially life-threatening complication of a myocardial infarction. We present the case of a 45-year-old male who was brought to the emergency department in extremis and had a previous history of a late presentation inferior ST-elevation myocardial infarction treated percutaneously. Clinical examination revealed evidence of cardiogenic shock, pulmonary edema and a pulsatile epigastric mass. Chest X-ray demonstrated marked cardiomegaly and pulmonary edema. Urgent echocardiography confirmed the presence of a huge basal inferior wall pseudo-aneurysm with bi-directional flow. This was also associated with severe mitral regurgitation, due to posterior mitral annular involvement. The patient was transferred to the local cardiothoracic surgical unit where he underwent emergency repair of the pseudo-aneurysm and mitral valve replacement. Despite the surgery being complex he made a full recovery.

Incidental Left Ventricular Aneurysm Discovered after Chest Pain Following a Motor Vehicle Collision

We report the case of a female with a history of coronary artery disease who came in with chest pain after a motor vehicle collision. Imaging revealed an incidental left ventricular aneurysm. The presentation and management of left ventricular aneurysms are discussed, along with imaging findings on computed tomography, plain radiography, and ultrasonography.

Primary effusion lymphoma in a human immunodeficiency virus-negative patient with unexpected unusual complications: a case report

BACKGROUND

Primary effusion lymphoma is a rare, high-grade non-Hodgkin's lymphoma that usually occurs in immunosuppressed or human immunodeficiency virus-positive individuals in advanced stages of the disease. However, primary effusion lymphoma occasionally affects immunocompetent patients who are infected with human herpes virus type 8 or Epstein-Barr virus. This disease manifests with liquid collections in cavities, producing constitutional symptoms; fever; weight loss; and symptoms related to extrinsic compression, such as dyspnea or abdominal discomfort. Diagnosis is confirmed with cytological or tissue evaluation showing large, multinucleated lymphoid cells with positive specific markers for the disease, such as CD45 and markers related to viral infections, when present. There is no standard treatment for primary effusion lymphoma, but several chemotherapy protocols are recommended, usually with poor results.

CASE PRESENTATION

We present a case of an adult human immunodeficiency virus-negative Hispanic origin woman with primary effusion lymphoma with pleuritic, pericardial, and peritoneal compromise who also had unusual complications during a diagnostic procedure: the accidental rupture of the left ventricle and the development of a secondary left ventricular pseudoaneurysm. We describe the clinical, radiological, and laboratory characteristics as well as the outcome of this case.

CONCLUSIONS

Primary effusion lymphoma is a very rare entity that represents 4% of non-Hodgkin's lymphoma cases associated with human immunodeficiency virus and 0.1% to 1% of all lymphomas in patients with another type of immunodeficiency in regions where human herpes virus type 8 is not endemic. This reported case is an unusual presentation of primary effusion lymphoma because it occurred in an immunocompetent human immunodeficiency virus-negative adult woman without the presence of Kaposi's sarcoma or Castleman's disease and for whom the clinical course after chemotherapy was successful. However, the rupture of the free wall of the left ventricle is a very rare catastrophic event that usually occurs after myocardial infarction. Left ventricle free wall rupture rarely goes unnoticed, but when it occurs, it leads to the development of a ventricular pseudoaneurysm in which the rupture is contained by the pericardium with an organized thrombus and an adjacent hematoma.

Significant incidental cardiac disease on thoracic CT: what the general radiologist needs to know

Objective

Incidental cardiac findings are often found on chest CT studies, some of which may be clinically significant. The objective of this pictorial review is to illustrate and describe the appearances and management of the most frequently encountered significant cardiac findings on non-electrocardiographically gated thoracic CT. Most radiologists will interpret multidetector chest CT and should be aware of the imaging appearances, significance, and the appropriate next management steps, when incidental significant cardiac disease is encountered on thoracic CT.

Conclusion

This article reviews significant incidental cardiac findings which may be encountered on chest CT studies. After completing this review, the reader should not only be familiar with recognizing clinically significant cardiac findings seen on thoracic CT examinations but also have the confidence to direct their further management.

An Unusual Suspect in a Case of Left Ventricular Aneurysm

True left ventricular aneurysms are most frequently seen after acute transmural myocardial infarction. These aneurysms are distinct from apical left ventricular pseudoaneurysms, which can also be seen in ischemia, and have a different treatment course. A major dilemma for clinicians is using echocardiographic information to make this distinction. Coronary angiography aids in this distinction; however, in the case of normal coronaries alternate etiologies must be considered. The differential for a patient with a left ventricular aneurysm and normal coronaries or no prior cardiac surgery is broad and includes traumatic, infectious and infiltrative causes. In this e-challenge, we present an unusual cause of a left ventricular apical aneurysm in a patient with normal coronary arteries residing in the United States.

Exertional dyspnea after myocardial infarction: thinking beyond the diagnosis of heart failure

INTRODUCTION

We herein present an unusual case of a pseudoaneurysm of the left ventricular myocardium, which is a rare and fatal complication of myocardial infarction.

CASE REPORT

A 64-year-old man with a history of bipolar disorder and arterial hypertension was hospitalized for delayed presentation ST-elevation myocardial infarction. He was admitted to our hospital 24 hours after symptom onset. Diagnostic coronary angiography revealed 95% stenosis at the distal third of the right coronary artery, and he underwent a primary percutaneous coronary intervention to the culprit lesion. Despite administration of a diuretic and optimization of other pharmaceutical treatment, his heart failure deteriorated. Electrocardiography showed a sinus rhythm with Q-wave formation in the inferior wall leads (II, III, aVF), T-wave inversion in the same leads, and borderline QT prolongation (QTc of 490 ms). No ST elevation suggestive of left ventricular aneurysm formation was noticed. Forty days later, cardiac ultrasound revealed a dyskinetic cavity (pseudoaneurysm) in continuity with the posterior-inferior wall of the myocardium, resulting in severe mitral valve regurgitation. Unfortunately, the patient died while awaiting surgical treatment.

CONCLUSION

Although most patients with left ventricular pseudoaneurysm have a relatively benign outcome, those with symptoms of heart failure must be urgently diagnosed and treated.

Left ventricular outflow tract pseudoaneurysm diagnosed with point-of-care ultrasound in the emergency department

Left ventricular outflow tract pseudoaneurysms are a rare but life-threatening disorder, often caused by complications of cardiac surgery or myocardial infarction. We present a case report of a patient with no prior risk factors who presented with a six-month history of progressive exertional dyspnea, bilateral leg swelling and cough. Point-of-care ultrasound revealed an unexpected outpouching of the left ventricle. He was diagnosed with a left ventricular outflow tract pseudoaneurysm and subsequently went into cardiogenic shock secondary to extension of pseudoaneurysm causing extrinsic compression of the coronary arteries. The patient underwent successful emergency surgical repair and made a full recovery.

Echocardiographic features of right ventricular diverticulum: A case report

Right ventricular diverticulum is a rare form of cardiac deformity, with a very few cases caused by pericarditis. A 60-year-old man sought medication because of chest congestion and shortness of breath. CT showed a soft tissue mass at the heart apex and pericardial calcification. Doppler echocardiography demonstrated a mixed cystic solid mass at the right ventricular apex. Surgical cure confirmed the diagnosis of right ventricular apex diverticulum with pericarditis. Echocardiography is contributive to the diagnosis of ventricular diverticula in measuring their size and showing the local thinning of the ventricular wall with localized bulging and abnormal motion. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:531-534, 2017.

Symmetrical peripheral gangrene complicating ventricular pseudoaneurysm: a report of an unusual case and a brief review of the literature

Symmetrical peripheral gangrene is an ischemic necrosis simultaneously involving the distal portions of two or more extremities without any proximal arterial obstruction or vasculitis. It may occur as a result of a large number of infectious and non-infectious causes. A few cases of symmetrical peripheral gangrene associated with cardiac disease have been described in the literature. We describe a case of symmetrical peripheral gangrene complicating ventricular pseudoaneurysm, probably a hitherto unreported occurrence. In this report, we sought to emphasize the importance of cardiac evaluation while dealing with a case of symmetrical peripheral gangrene.

Left Ventricular Pseudoaneurysm Following Inferior Myocardial Infarction: A Case for Conservative Management

Left ventricular pseudoaneurysm is a rare complication of myocardial infarction that carries a high mortality rate. Although conventional wisdom suggests prompt surgical repair in order to mitigate risk of expansion and rupture, there are some data to support non-operative management in asymptomatic individuals with likely chronic pseudoaneurysms, particularly when surgical candidacy is poor. We present a case of a medically managed left ventricular pseudoaneurysm subsequent to inferior ST-segment elevation myocardial infarction with 6-month follow-up data.

Left ventricular pseudoaneurysm versus aneurysm a diagnosis dilemma

Free wall rupture of the left ventricle (LV) is a rare but life-threatening complication of acute myocardial infaction. Very rarely such rupture may be contained by the adhering pericardium creating a pseudoaneurysm. This condition warrants for an emergency surgery. Left ventricular aneurysm is the discrete thinning of the ventricular wall (<5 mm) with akinetic or dyskinetic wall motion causing an out-pouching of the ventricle. Given the propensity for pseudoaneurysms to rupture leading to cardiac tamponade, shock, and death, compared with a more benign natural history for true aneurysms, accurate diagnosis of these conditions is important. True aneurysm, usually, calls for an elective surgery. Clinically differentiating the two conditions remains a challenge. We report the case of a patient with LV pseudoaneurysm, initially diagnosed as true aneurysm at our institution. We have attempted to review the existing literature and discussed the characteristic findings of each entity.

Multiple left ventricular aneurysms in a young female

Multiple left ventricular aneurysms (LVAs) are rare, especially in a young female. A 29-year-old woman presented vague symptoms. Multiple LVAs were revealed and confirmed on different imaging modalities, including chest radiography, echocardiography, contrast ventriculography and cardiac magnetic resonance imaging. Detailed work-up for probable etiologies including ischemic, infectious, inflammatory and autoimmune causes was negative. In the absence of angina, decompensated congestive heart failure, arrhythmias and embolism, the patient was managed conservatively, with excellent mid-term outcome.

Repair of left ventricular pseudoaneurysm with the triple patch technique (Empanada Patch)

Left ventricular pseudoaneurysm is a rare but serious complication of myocardial infarction that requires urgent intervention to avoid unpredictable fatal rupture. Surgical repair aims at excluding the aneurysmal area with a patch to preserve the left ventricular geometry. Here, we present a case of successful repair of inferobasal left ventricular pseudoaneurysm using a modified triple patch technique ('Empanada Patch').

Surgical treatment of giant cardiac aneurysm with pseudoaneurysm in a colon carcinoma patient

Left ventricular pseudoaneurysm is a rare and lethal condition associated with a high risk of rapid enlargement and rupture. It develops after transmural myocardial infarction (MI), cardiac surgery, trauma, or infection. When a left ventricular pseudoaneurysm is detected, surgical repair is recommended due to the high possibility of rupture. In this report, we present surgical treatment of a giant cardiac pseudoaneurysm that occurred after MI in a colon carcinoma patient.

A large pseudoaneurysm of the left cardiac ventricle in a 57-year-old patient after urgent coronary artery bypass grafting and surgical mitral valve replacement due to acute myocardial infarction

We present a rare case of a left ventricular pseudoaneurysm in a patient after inferior wall myocardial infarction. The infarction was complicated with acute mitral insufficiency, pulmonary edema, and cardiogenic shock. Urgent surgical mitral valve replacement and coronary artery bypass grafting were performed. After several months, the patient was hospitalized again because of deterioration of exercise tolerance and symptoms of acute congestive heart failure. A large pseudoaneurysm of the left ventricle was recognized and successfully treated surgically.

A life-threatening infective pseudoaneurysm of the left ventricle in a toddler

Pseudoaneurysms of the ventricle are an uncommon occurrence in children. They may be secondary to previous cardiac surgery or infection of the pericardial space. Infective pseudoaneurysms require urgent surgery because rupture of the pseudoaneurysm may have catastrophic consequences. The outcome with surgery is excellent. We report a toddler with ruptured pseudoaneurysm secondary to purulent pericarditis who recovered with an emergency surgical closure of the opening of the pseudo-aneurysm.

Left ventricular pseudoaneurysm formation: Two cases and review of the literature

Left ventricular wall rupture (LVWR) comprises a complication of acute myocardial infarction (AMI). Acute LVWR is a fatal condition, unless the formation of a pseudoaneurysm occurs. Several risk factors have been described, predisposing to LVWR. High index of suspicion and imaging techniques, namely echocardiography and computed tomography, are the cornerstones of timely diagnosis of the condition. As LVWR usually leads to death, emergency surgery is the treatment of choice, resulting in significant reduction in mortality and providing favorable short-term outcomes and adequate prognosis during late follow-up. Herein, we present two patients who were diagnosed with LVWR following AMI, and subsequent pseudoaneurysm formation. In parallel, we review the aforementioned condition.

Huge left ventricular pseudoaneurysm rupture in an African young adult patient

A pseudoaneurysm of the ventricle is formed when there is rupture of the myocardial wall with the discontinuity being roofed over by the pericardium and mural thrombus or fibrous tissue without myocardial elements. Cardiac pseudoaneurysm is a rare and a potentially life-threatening event. Early prophylactic surgical aneurysmectomy has been the treatment of choice. In this context, we report an unusual case of giant left ventricular pseudoaneurysm, as a result of unknown aetiology, appearing like a pulsatile mass, which was easily seen from the chest wall, in a young female, successfully treated with surgery.

Ruptured left ventricular pseudoaneurysm in the mediastinum following acute myocardial infarction: a case report

Left ventricular pseudoaneurysm is an uncommon complication after transmural acute myocardial infarction (AMI). Here we describe the case of a 43-year-old man who presented with AMI and chest distress despite the normal appearance of his coronary artery during coronary angiography. Timely thrombolytic therapy was administered. Echocardiography, and cardiac computed tomography showed a ventricular pseudoaneurysm, and direct visualization at the time of surgery showed that it had ruptured in the mediastinum instead of the pericardium. The survival rate of patients with ventricular pseudoaneurysm rupture is low. The rupture of ventricular pseudoaneurysm in the mediastinum is rare; therefore, this case is noteworthy.

Spectrum of physiological and pathological cardiac and pericardial uptake of FDG in oncology PET-CT

Cardiac uptake of 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG) is frequently observed on FDG positron-emission tomography combined with computed tomography (PET-CT) performed for diagnosis, staging, and assessment of therapeutic response of lymphoma and solid cancers, despite careful patient preparation to limit myocardial glucose substrate utilisation. We illustrate the varied physiological patterns of cardiac FDG uptake, and show a spectrum of pathological conditions causing FDG uptake within myocardial and pericardial structures, due to clinically important benign and malignant diseases. Recognition and awareness of these various causes of FDG uptake in the heart, along with the appropriate use of correlative contrast-enhanced CT and magnetic resonance imaging (MRI) will facilitate correct interpretation.

With computed tomography confirmed anterolateral left ventricular pseudoaneurysm in patient with dilatative alcoholic cardiomyopathy

Background

Pseudoaneurysms are rare complications of myocardial infarction with propensity for rupture. There is still a challenge with which diagnostic imaging we performed a final diagnosis of pseudoaneurysm and differentiate it from true aneurysm what is clinically important due to the different treatment.

Case report.

We presented the unusual case of a 56-year-old man with signs of decompensated heart failure which had worsened a few months before hospitalization. We believed that during worsening of symptoms the patient suffered a silent myocardial infarction complicated by subacute free wall rupture which resulted into left ventricular pseudoaneurysm formation without tamponade. Echocardiography showed dilatative cardiomyopathy which was already present years before and a very rare location of the left ventricular pseudoaneurysm on the anterolateral part of the left ventricle. Pseudoaneurysm was confirmed with CT scan. Due to the severity of contractile dysfunction and no response in treatment for congestive heart failure the directive for the resection was tempered and the patient died due to the progressive heart failure and embolic phenomena.

Conclusions

This report shows the importance of non-invasive imaging diagnostic evaluation of acute decompensated heart failure where echocardiography and chest X-ray are the first diagnostic steps. Based on those findings further imaging diagnostic steps must be performed such as CT scan in our case which finally confirms left ventricular pseudoaneurysm with dilatative cardiomyopathy.

[Left ventricular aneurysm and differential diagnosis with pseudoaneurysm]

Left ventricular aneurysm and pseudoaneurysm are two complications of myocardial infarction in which the role of imaging is paramount. The authors describe a case of a true aneurysm of the posterior wall, for which cardiac magnetic resonance was useful, although only intra-operative assessment confirmed the diagnosis.

Normal coronary artery patient presenting with left ventricular aneurysm

Left ventricular aneurysm (LVA) is one of the most important complications of myocardial infarction LVA is strictly defined as a distinct area of abnormal left ventricular diastolic contour with systolic dyskinesia or paradoxical bulging. LVA usually results from myocardial infarction. Other rare aetiologies of LVA include hypertrophic cardiomyopathy, Chagas' disease, sarcoidosis, congenital LVA, and idiopathic However, LVA formation in patients with idiopathic dilated cardiomyopathy is rarely reported, and the incidence, clinical features, and pathogenesis of LVA formation in patients with idiopathic dilated cardiomyopathy is not well understood. Here, we present a 45 years old, idiopathic dilated cardiomyopathy patient with LVA and normal coronary arteries The pathogenesis of LVA formation in patients with idiopathic dilated cardiomyopathy is not clear. One acceptable hypothesis is that coronary artery emboli originate from mural thrombi, present in some patients with idiopathic dilated cardiomyopathy, which develop due to local wall infarction and fibrosis. The local myocardial perfusion differences could be seen in idiopathic dilated cardiomyopathy and predominantly found in the anteroposterior axis of the left ventricle. Local fibrosis occurs more frequently on the anterior wall or posterior wall, and less frequently on the lateral or septal wall. In our patient, LVA existed in the septal segments.We could not define the exact mechanism of the septal aneurysm in our patient but we decided to present this abnormal case, which is different from cases thus far reported in the literature.