No abstract

A 66-year-old woman (169 cm, 70 kg) with known 3-vessel coronary artery disease, a mildly reduced left ventricular (LV) ejection fraction (55% by echocardiography), and a history of anterior myocardial infarction (1997) underwent routine echocardiography that showed a thrombus-like, mobile formation at the apex. Transthoracic and transesophageal echocardiography did not clarify the situation. Consequently, contrast-enhanced cardiac MRI was performed to evaluate LV function, depict size of the myocardial infarction, and differentiate apical pathology using a 1.5-T scanner (Siemens Magnetom Sonata Maesto Class).Horizontal long-axis breath-hold cine-MR (TRUE-Fisp) showed akinetic apical and septal segments with apical wall thinning and no typical myocardium. Between the LV chamber and the apex, a membranous border with signs of turbulence ("voids") indicates a communication between the left ventricle and a "chronic" pseudoaneurysm (Figures 1 and 2). T1-weighted (Segmented Inversion recovery Turbo-FLASH) image acquisition showed transmural scarring in the anteroapical segments (Figure 3). There were no signs of thrombus formation.