This is a case of a leaking pseudoaneurysm at the left ventricular apex with moderate hemopericardium. Left ventricular aneurysms and pseudoaneurysms are two complications of myocardial infarction that can lead to death or serious morbidity. The pseudoaneurysm, or false aneurysm, develops after an acute MI that is complicated by a ventricular free wall rupture that is sealed by pericardial adhesions, however, true aneurysm will have intact wall with no bleeding.

The patient was taken to the operative room for emergent repair.

Intra-operative trans-esophageal echocardiogram (TEE)  

• left ventricle
  • large posterior (apical) ruptured aneurysm, around 4 cm in diameter, communicating with a contained pericardial sac
  • large dyskinetic apex
  • LVEF >50% however significant portion leaving the apex into the pericardial sac
• right ventricle: normal
• left Atrium: normal
• right Atrium: normal

Histopathology

Left ventricular thrombus and aneurysm, excision.  Multiple fragments of organizing thrombus. 

Microscopic Description

Sections from the left ventricular thrombus reveal fragments of organized clot. There is no evidence for malignancy. Sections from the left ventricular aneurysm/pseudoaneurysm reveal benign fragments of blood clot with mixed inflammatory changes. There is no evidence for granulomatous inflammation or malignancy. No cardiac muscle identified.