Published in:
01-07-2016 | Imaging in Intensive Care Medicine
Heart failure after acute myocardial infarction: giant pseudoaneurysm that was difficult to diagnose because of imaging techniques
Published in: Intensive Care Medicine | Issue 7/2016
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A 61-year-old man, with a recent history of myocardial infarction, presented with heart failure. Cardiac magnetic resonance (MR) identified a transmural infarction with wall thinning of the basal inferior and inferolateral segments (Fig. 1a, b). Initially, the diagnosis of cardiac aneurysm was made. Transthoracic echocardiography demonstrated a large cavity in the inferoposterolateral region, with systolic expansion and bidirectional flow (Fig. 1c). Despite having a broad base it suggested the presence of a pseudoaneurysm that was confirmed by surgery. It was repaired using a bovine pericardial patch (Fig. 1d).
Fig. 1
Cardiac MR short axis view (a) and three-chamber view (b) showing a large pseudoaneurysm of the inferolateral and inferobasal wall. The presence of a wide neck could lead to misinterpretation as a true aneurysm. A pseudoaneurysm is typically contained by the pericardium, thrombus, or adhesions (purple arrow). Transthoracic echocardiography (TTE) three-chamber view (c) demonstrating an inferobasal extensive cavity with systolic bulging. The Doppler analysis showed bidirectional flow and mild mitral regurgitation (red arrow). d Pre-discharge TTE three-chamber view. Moderate clotted effusion in the aneurysmectomy area. RV right ventricle, LV left ventricle, PSA pseudoaneurysm, LA left atrium, AA ascending aorta, CE clotted effusion
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