Ventricular pseudoaneurysm after subacute myocardial infarction

Bekkers, Sebastiaan C.A.M.; Borghans, Rob; Cheriex, Emile C.

doi:10.1007/s10554-006-9100-0

Cited by 13 publications

(26 citation statements)

References 21 publications

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“…Pseudoaneurysms are typically diagnosed with a delay of 6 months after infarction. The explanation for the development of a pseudoaneurysm is that the cardiac rupture is limited by pre-existing adhesions between the epicardium and the pericardium [60]. They are often located in the inferior or posterolateral wall [61].…”

Section: Acute Aortic Dissectionmentioning

confidence: 99%

Triple rule-out CT in the emergency department: protocols and spectrum of imaging findings

et al. 2008

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Triage decisions in patients suffering from acute chest pain remain a challenge. The patient's history, initial cardiac enzyme levels, or initial electrocardiograms (ECG) often do not allow selecting the patients in whom further tests are needed. Numerous vascular and non-vascular chest problems, such as pulmonary embolism (PE), aortic dissection, or acute coronary syndrome, as well as pulmonary, pleural, or osseous lesions, must be taken into account. Nowadays, contrast-enhanced multi-detector-row computed tomography (CT) has replaced previous invasive diagnostic procedures and currently represents the imaging modality of choice when the clinical suspicion of PE or acute aortic syndrome is raised. At the same time, CT is capable of detecting a multitude of non-vascular causes of acute chest pain, such as pneumonia, pericarditis, or fractures. Recent technical advances in CT technology have also shown great advantages for non-invasive imaging of the coronary arteries. In patients with acute chest pain, the optimization of triage decisions and cost-effectiveness using cardiac CT in the emergency department have been repetitively demonstrated. Triple rule-out CT denominates an ECG-gated protocol that allows for the depiction of the pulmonary arteries, thoracic aorta, and coronary arteries within a single examination. This can be accomplished through the use of a dedicated contrast media administration regimen resulting in a simultaneous attenuation of the three vessel territories. This review is intended to demonstrate CT parameters and contrast media administration protocols for performing a triple rule-out CT and discusses radiation dose issues pertinent to the protocol. Typical life-threatening and non-life-threatening diseases causing acute chest pain are illustrated. Triple rule-out CT in the emergency department: protocols and spectrum of imaging findings Abstract Triage decisions in patients suffering from acute chest pain remain a challenge. The patient's history, initial cardiac enzyme levels, or initial electrocardiograms (ECG) often do not allow selecting the patients in whom further tests are needed. Numerous vascular and non-vascular chest problems, such as pulmonary embolism (PE), aortic dissection, or acute coronary syndrome, as well as pulmonary, pleural, or osseous lesions, must be taken into account. Nowadays, contrast-enhanced multidetector-row computed tomography (CT) has replaced previous invasive diagnostic procedures and currently represents the imaging modality of choice when the clinical suspicion of PE or acute aortic syndrome is raised. At the same time, CT is capable of detecting a multitude of non-vascular causes of acute chest pain, such as pneumonia, pericarditis, or fractures. Recent technical advances in CT technology have also shown great advantages for non-invasive imaging of the coronary arteries. In patients with acute chest pain, the optimization of triage decisions and cost-effectiveness using cardiac CT in the emergency department have been repetitively demonstrated....

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Section: Acute Aortic Dissectionmentioning

confidence: 99%

Triple rule-out CT in the emergency department: protocols and spectrum of imaging findings

et al. 2008

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“…Za dijagnozu PAN najveći značaj ima ehokardiografija, takođe ventrikulografija, kompjuterizovana tomografija, magnetna rezonanca. 1,[3][4][5] Hronične PAN se otkrivaju slučajno u 10-20 % slučajeva, u proseku oko 4 meseca posle akutnog infarkta. 4,14 Zbog preteće rupture terapija PAN je urgentna hirurgija (operativni rizik 25-28 %).…”

Section: Slikaunclassified

“…Konzervativni tretman i dugotrajno preživljavanje su mogući kod nekih pacijenata. 1,15 U slučaju našeg pacijenta hronična PAN je otkrivena slučajno. Postavlja se pitanje da li je subakutna ruptura slobodnog zida leve komore mogla biti prepoznata 5 godina ranije u fazi AMI.…”

Section: Slikaunclassified

“…Najčešći uzrok PAN je akutni infarkt miokarda (55 %), a ređe srča-na hirurgija (33 %), trauma (7 %), infekcija (5 %). [1][2][3][4][5] U većini slučajeva postinfarktna PAN je locirana posterolateralno. Manifestuje se znacima srčane insuficijencije, aritmijama, trombo-embolijskim događajima i kao naprasna smrt.…”

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“…3,4 Zbog velike sklonosti rupturi bez obzira na hronicitet, terapija je hirurška, mada su opisane neoperisane PAN sa dugotrajnim preživljavanjem. 1,3,5 Važ-no je napraviti diferencijalnu dijagnozu prema pravoj komorskoj aneurizmi (AN). 1,[6][7] …”

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Left ventricular pseudoaneurism

Boričić-Kostić¹,

Tomić²,

Boričić³

et al. 2012

Srce i krvni sudovi

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Prikazan je pacijent star 72 godine sa pseudoaneurizmom (PAN) leve komore koja je otkrivena slučajno, pri rutinskom ehokardiografskom pregledu. Ruptura slobodnog zida leve komore ostala je neprepoznata pet godina ranije, kada je pacijent preboleo akutni infarkt miokarda (AMI) infero-postero-lateralne (IPL) lokalizacije. Pacijent je dugogodišnji bolesnik od reumatoidnog artritisa. Urađe-na je uspešna hirurška resekcija pseudoaneurizme. U radu diskutujemo da li je bilo moguće postaviti dijagnozu rupture srca u vreme kada se desila i razmatramo moguću vezu kardiovaskularne bolesti i reumatoidnog artritisa.Ruptura slobodnog zida leve komore, pseudoaneurizma leve komore, reumatoidni artritis SažetakKontakt: Dr Marija Boričić Kostić, Klinika za kardiologiju, Klinički centar Srbije, Koste Todorovića 8, 11000 Beograd, Srbija, tel: +381642578446, E-mail: marijaboricickostic@yahoo.com Ključne rečiUvod P seudoaneurizma leve komore nastaje kao posledica rupture slobodnog zida komore. Najčešći uzrok PAN je akutni infarkt miokarda (55 %), a ređe srča-na hirurgija (33 %), trauma (7 %), infekcija (5 %). 1-5 U većini slučajeva postinfarktna PAN je locirana posterolateralno. Manifestuje se znacima srčane insuficijencije, aritmijama, trombo-embolijskim događajima i kao naprasna smrt. 3,4 Zbog velike sklonosti rupturi bez obzira na hronicitet, terapija je hirurška, mada su opisane neoperisane PAN sa dugotrajnim preživljavanjem. 1,3,5 Važ-no je napraviti diferencijalnu dijagnozu prema pravoj komorskoj aneurizmi (AN). 1,[6][7] Prikaz slučajaPacijent muškog pola star 72 godine upućen je na ehokardiografski pregled zbog zamaranja pri malom fizič-kom naporu i poremećaja srčanog ritma. Preboleo je infarkt srca pre pet godina, pušač je, ima dugogodišnju arterijsku hipertenziju, hronični opstruktivni bronhitis, bubrežnu insuficijenciju blažeg stepena i seropozitivni, visokoevolutivni, erozivni reumatoidni artritis (RA) od 21. godine života. Ranije je lečen solima zlata, Leflunomidom i Sulfasalazinom. Posle prebolelog infarkta srca od lekova koristi nitrate dugog dejstva, ACE inhibitore, Amjodaron, diuretike, aspirin i nesteroidne antireumatike.Transtoraksni ehokardiografski pregled pokazao je da je leva komora povećana (EDD 6.2 cm, ESD 4.5 cm), hipertrofičnih zidova, uočava se IPL ožiljak, ruptura bazalnog segmenta lateralnog zida i velika posterolateralna PAN promera 6.0 x 2.5 cm (Slika 1,2,3). U lumenu PAN vidi se gusta vrtložna krv, a prizidno se uočava tromb. Anteroseptalni segmenti i vrh komore su trabekularni, dobro kontraktilni. Aorta je normalne širine, sklerotičnog zida, aortni velumi su malo deblji, dobro se separiraju i postoji 1-2+ aortna regurgitacija. Mitralni listići su normalnog izgleda i pokretljivosti, a u lako većoj levoj pretkomori zapaža se 1+ mitralna regurgitacija. Desne srčane šupljine nisu povećane, postoji 1-2+ trikuspidna regurgitacija. Sistolni pritisak u desnoj komori je oko 40 mmHg. U perikardu i pleurama nema slobodne tečnosti.Posle ovog neočekivanog ehokardiografskog nalaza pacijent je hospitalizovan radi d...

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