Multimodality Imaging in a Case of Chronic Massive Left Ventricular Pseudoaneurysm

Reyaldeen, Reza; Jeffries, C.; Hardman, Desmond; Challa, P.; Dahiya, Arun

doi:10.1016/j.case.2017.11.003

Cited by 7 publications

(5 citation statements)

References 15 publications

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“…A sharp, delayed pericardial enhancement is a common finding of CMRI in patients with LVPs 16 . Broad utilization of these noninvasive imaging modalities helps in the diagnosis and anatomic demarcation of LVPs for surgical planning 3 , 17 .…”

Section: Clinical Discussionmentioning

confidence: 99%

Acute limb ischemia from embolization of left ventricular pseudoaneurysm thrombus: a rare case report

Ismayl

Radaideh

Abusnina

et al. 2023

Annals of Medicine &Amp; Surgery

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Introduction and importance: Myocardial infarction (MI) can lead to a wide spectrum of mechanical complications. Left ventricular pseudoaneurysm (LVP) is a rare but serious complication of MI. Case presentation: A 69-year-old woman with prior coronary artery bypass grafting and a remote history of inferolateral ST-elevation MI (STEMI) with failure to revascularize the left circumflex artery presented with gangrenous right toes that appeared 2 years after her STEMI. A computed tomography angiogram of the right lower extremity showed arterial occlusion and mild atherosclerotic disease. Echocardiography revealed a pseudoaneurysm with an adherent mural thrombus as the underlying cause of acute limb ischemia. The patient was started on heparin and cardiothoracic surgery was consulted but did not operate as the risk of surgery outweighed the benefit. On hospital day 3, the patient underwent amputation of her gangrenous toes as the tissue was nonviable. The patient remained stable during her hospital stay and was discharged on day 5 on long-term anticoagulation. Clinical discussion: LVPs have a wide spectrum of presentations, from asymptomatic or nonspecific symptoms to thromboembolism with end-organ damage, such as in our case. Therefore, early diagnosis and management are of paramount importance. Our patient’s prior coronary artery bypass grafting most likely helped in forming a fibrous pericardium that sealed the pseudoaneurysm and prevented its rupture. Conclusions: STEMI requires close follow-up, especially in cases where revascularization is not achievable, as the risk of mechanical complications and mortality is high. Physicians should have a high suspicion for LVP in patients with prior MI, given its wide spectrum of presentations.

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Section: Clinical Discussionmentioning

confidence: 99%

Acute limb ischemia from embolization of left ventricular pseudoaneurysm thrombus: a rare case report

Ismayl

Radaideh

Abusnina

et al. 2023

Annals of Medicine &Amp; Surgery

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“…If surgery is not performed, conservative management options include guideline-directed medical therapy (GDMT) for associated heart failure and consideration for percutaneous repair. 3 , 5 …”

Section: Discussionmentioning

confidence: 99%

Case report: large left ventricular aneurysm with contained rupture and haemopericardium

WILLETT

GLENN

Rose-Malkamäki

et al. 2023

European Heart Journal - Case Reports

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Background Recent advancements in cardiology have significantly decreased the incidence of post-myocardial infarction mechanical complications. When these sequelae occur, they can have high morbidity and mortality and may require aggressive intervention. Case Summary We describe a case of contained rupture of a large left ventricular aneurysm (LVA) presenting with syncope in a 60-year-old male with late presentation myocardial infarction (MI) 6 weeks prior on home triple antithrombotic therapy (TAT). Urgent pericardiocentesis along with imaging techniques including ultrasound, computed tomography (CT), and cardiac magnetic resonance imaging (MRI) were used for initial diagnosis. Definitive treatment was achieved with excision and repair of the LVA with return to prior functional status 1 month after intervention. Discussion Highlights of this report emphasize the importance of differential diagnosis consideration of LVA with contained rupture in patient populations with prior late presentation MI and TAT. High clinical suspicion and thorough diagnostic workup with appropriate imaging are important to guide appropriate treatment interventions.

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“…However, medical management with pharmacotherapy for optimizing heart failure and strict blood pressure control for minimizing wall stress can be a therapeutic option for patients with small pseudoaneurysms (<3 cm diameter) and asymptomatic. 6 , 7 …”

Section: Discussionmentioning

confidence: 99%

“… 2 Furthermore, Kaur et al, and Reyaldeen et al described case reports with medically managed left ventricular pseudoaneurysms with clinically stable lesions after 3 months and 12 months of follow-up, respectively. 7 , 8 …”

Section: Discussionmentioning

confidence: 99%

Contained Left Ventricular Free Wall Rupture Following a Silent Myocardial Infarction

Elkattawy,

Romero,

Romero

et al. 2023

Journal of Community Hospital Internal Medicine Perspectives

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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.

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Multimodality Imaging in a Case of Chronic Massive Left Ventricular Pseudoaneurysm

Abstract: Graphical abstract

Cited by 7 publications

References 15 publications

Acute limb ischemia from embolization of left ventricular pseudoaneurysm thrombus: a rare case report

Acute limb ischemia from embolization of left ventricular pseudoaneurysm thrombus: a rare case report

Case report: large left ventricular aneurysm with contained rupture and haemopericardium

Contained Left Ventricular Free Wall Rupture Following a Silent Myocardial Infarction

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