Contained Left Ventricular Free Wall Rupture following Myocardial Infarction

Abstract

Rupture of the free wall of the left ventricle occurs in approximately 4% of patients with infarcts and accounts for approximately 20% of the total mortality of patients with myocardial infractions. Relatively few cases are diagnosed before death. Several distinct clinical forms of ventricular free wall rupture have been identified. Sudden rupture with massive hemorrhage into the pericardium is the most common form; in a third of the cases, the course is subacute with slow and sometimes repetitive hemorrhage into the pericardial cavity. Left ventricular pseudoaneurysms generally occur as a consequence of left ventricular free wall rupture covered by a portion of pericardium, in contrast to a true aneurysm, which is formed of myocardial tissue. Here, we report a case of contained left ventricular free wall rupture following myocardial infarction.

Figure 1

Twelve-lead ECG of the patient: sinus rhythm 73 p/minute, axis of 5 degrees with pathological Q waves in leads V4–V6, ST-segment elevations in leads V1–V3, and T wave inversions in V1–V6 and in leads I and AVL.

Figure 2

(a) A posterior-anterior X-ray of the chest which reveals a space-occupying lesion with clearly defined borders. The lesion is of single consistency without calcification and merges with the lower border of the heart situated at a wide angle to the shadow of the heart, appearing as a mass in the anterior middle mediastinum. (b) Computerized tomography scan reveals a cystic process in the anterior middle mediastinale region with a double layer of fluid, one of which is consistent with blood. The process merges with the left ventricle. (c) CT Frame 205 of the same exam revealed thinning of the posterior lateral wall of the left ventricle with an aneurysm of approximately 50 millimeters, expanding from the left ventricle.