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Case Reports
. 2019 Aug 29;6(4):K19-K22.
doi: 10.1530/ERP-19-0018. eCollection 2019 Dec.

Acute respiratory distress secondary to a huge chronic left ventricular pseudo-aneurysm

Jonathan Hinton  1 , George Hunter  2 , Madhava Dissanayake  2 , Rob Hatrick  2
Affiliations
Case Reports

Acute respiratory distress secondary to a huge chronic left ventricular pseudo-aneurysm

Jonathan Hinton et al. Echo Res Pract. .

Abstract

Pseudo-aneurysms are a rare, potentially life-threatening complication of a myocardial infarction. We present the case of a 45-year-old male who was brought to the emergency department in extremis and had a previous history of a late presentation inferior ST-elevation myocardial infarction treated percutaneously. Clinical examination revealed evidence of cardiogenic shock, pulmonary edema and a pulsatile epigastric mass. Chest X-ray demonstrated marked cardiomegaly and pulmonary edema. Urgent echocardiography confirmed the presence of a huge basal inferior wall pseudo-aneurysm with bi-directional flow. This was also associated with severe mitral regurgitation, due to posterior mitral annular involvement. The patient was transferred to the local cardiothoracic surgical unit where he underwent emergency repair of the pseudo-aneurysm and mitral valve replacement. Despite the surgery being complex he made a full recovery.

Keywords: left ventricular pseudo-aneurysm; myocardial infarction.

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Figures

Figure 1
Figure 1
AP chest X-ray, demonstrating cardiomegaly and pulmonary edema.
Figure 2
Figure 2
Parasternal short axis at papillary muscle level.
Figure 3
Figure 3
Apical two-chamber view.
Figure 4
Figure 4
Apical two-chamber with color flow, demonstrating flow into the pseudo-anuerysm and severe mitral regurgitation.
Figure 5
Figure 5
Post-operative apical two chamber.
See this image and copyright information in PMC

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