Left ventricular pseudoaneurysm

Case contributed by Dr Maxime St-Amant

Presentation

Patient with prior medical history of myocardial infarction.

Patient Data

Age: 76
Gender: Male
X-ray

There is a focal bulging of the left ventricle, with small parietal calcifications. It is seen in both P.A. and lateral projections. The patient had a known left ventricular pseudo-aneurysm post-myocardial infarction.

Case Discussion

Left ventricular pseudo-aneurysm must be distinguished from a left ventricular aneurysm.  

A pseudo-aneurysm (or false aneurysm) arises post-myocardial infarction or post chest trauma, and is consequent to rupture of the myocardial free-wall, which occurs days post infarction, and fortiutously becomes limited by a pericardial adhesion (without this, myocardial rupture is usually rapidly fatal). Thus, the pseudo-aneurysm wall consists only of epicardium, pericardium and haematoma. Left ventricular pseudo-aneurysms remain at risk of rupture, more so shortly after the precipitating event. They are commonly posterolateral.

In contrast, a left ventricular aneurysm is a more stable acquired, or rarely congenital pathology. These true aneurysms of the ventricular wall are bounded by scarred myocardium and are commonly a late complication of large transmural infarcts Complications of ventricular aneurysms include mural thrombus, arrhythmias, and heart failure; rupture of the tough fibrotic wall is not a concern. They tend to be anterolatera or apical, and often calcify with time.

 It is rarely seen on chest x-ray, since smaller, with a wider neck than pseudo-aneurysm.

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Case information

rID: 18598
Case created: 14th Jul 2012
Last edited: 6th Dec 2015
Systems: Chest, Cardiac
Inclusion in quiz mode: Included

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