Left ventricular pseudoaneurysm: A case report and review of the literature

Abstract

Left ventricular (LV) pseudoaneurysm is a rare complication that is reported in less than 0.1% of all patients with myocardial infarction. It is the result of cardiac rupture contained by the pericardium and is characterized by the absence of myocardial tissue in its wall unlike true aneurysm which involves full thickness of the cardiac wall. The clinical presentation of these patients is nonspecific, making the diagnosis challenging. Transthoracic echocardiogram and cardiac magnetic resonance imaging are the noninvasive modalities whereas coronary arteriography and left ventriculography are invasive modalities used for the diagnosis. As this condition is lethal, prompt diagnosis and timely management is vital.

Keywords: Chest pain; Left ventricular aneurysm; Left ventricular pseudoaneurysm; Myocardial infarction; Transthoracic echocardiogram.

Figure 1

Electrocardiogram shows 1.5 to 2 mm ST elevation in I, aVL, 1 to 2 mm ST depression in II , aVF, V1 to V4, and R/S ratio > 1 in V1 and V2.

Figure 2

Chest X-ray: Convexity on the lateral wall of the cardiac silhouette (white arrow).

Figure 3

Transthoracic echocardiogram: Apical modified 4/5 chamber view showing bidirectional shunt through the left ventricular wall (white arrow).

Figure 4

Transesophageal echocardiogram: 2 chamber view confirming the to and fro flow between left ventricle and the pseudo aneurysm (white arrow).

Figure 5

Cardiac magnetic resonance imaging: 4 chamber view showing the connection between the left ventricular cavity and the left ventricular pseudo aneurysm (white arrow). LV: Left ventricular; PA: Pseudoaneurysm.