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Cardiovascular


Monday, October 27, 2003

4:15 PM - 5:45 PM

Left Ventricular Pseudoaneurysm

Emad H. Ibrahim, MD* and Khaled Moghazy, MD

Alexandria Faculty of Medcicine, Alexandria, Egypt

INTRODUCTION: Left ventricular aneurysms are a frequent sequela of transmural myocardial infarction. The vast majority is true aneurysms and false are rare (12).

CASE PRESENTATIONS: A 53-year-old women presented by recurrent left-sided, sharp chest pain for two months. Her medical history and examination were insignificant. Chest X-ray was unremarkable.

Computed tomography (CT) showed a 3.5-cm diameter pseudoaneurysm emanating from the lateral aspect of the left ventricle.

Magnetic resonance imaging (MRI) defined a 5x3-cm oval pseudoaneurysm extending from the anterolateral wall of the left ventricle. A jet phenomenon is noted at the site of communication between the cavity of the left ventricle.Cardiac Cineangiography confirmed the presence of a pseudoaneurysmal cavity connected to the left ventricle.

DISCUSSION: A pseudoaneurysm is the consequence of rupture of the cardiac wall within extra-cardiac hematoma; its lumen communicates with the ventricle. In CT, the presence of a typical neck is not always diagnostic of a pseudoaneurysm, and sometimes the neck is not clearly demarcated. A keystone in diagnostic imaging with angiography, echocardiography, and radionuclide studies is the visualization of a "typical neck"(12).

CONCLUSIONS: The use of combined diagnostic radiology techniques (CT and MRI) and Cardiac cineangiography help in the diagnosis of ventricular pseudoaneurysm.



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  		Chest X-ray PA view.

 


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  		Axial CT scan shows a pseudoaneurysm (A) emanating from the lateral aspect of the left ventricle (LV).

 


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  		Postcontrast axial CT scan shows the pseudoaneurysmal cavity (arrow).

Figure [4]: (A, B, C) Cine gradient echo coronal MRI (A) & (B) ECG-gated horizontal long-axis and short axis (C) spin-echo MR images show a narrow ostium (arrow) communicating the pseudoaneurysm (A) and the left ventricular (LV).

 


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  		Cardiac cineangiography shows a pseudoaneurysmal cavity connected with the left ventricle (arrow).

 
DISCLOSURE: E.H. Ibrahim, None.

REFERENCES

  1. Duvernoy O, et al. Pre- and postoperative CT and MR in pseudoaneurysms of the heart. J Comput Assist Tomogr. 1992;16:401–409
  2. Higgins CB, et al. False aneurysms of the left ventricle. Identification of distinctive clinical, radiographic, and angiographic features. Radiology. 1978;127:21–27





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