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Circulation. 2004;109:550
doi: 10.1161/01.CIR.0000109526.50291.56
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(Circulation. 2004;109:550.)
© 2004 American Heart Association, Inc.


Images in Cardiovascular Medicine

Traumatic False Aneurysm of the Left Ventricle

Elmar Spuentrup, MD; Henning Schubert, MD

From the Department of Diagnostic Radiology, Technical University of Aachen, Aachen, Germany (E.S., H.S.), and Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass (E.S.).

Correspondence to Elmar Spuentrup, MD, Department of Diagnostic Radiology, University Hospital, Technical University of Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany. E-mail spuenti{at}rad.rwth-aachen.de

A 34-year-man was involved in a severe traffic accident 3 years before his current admission and sustained multiple rib and midfacial fractures as well as lung contusion. After 2 months, complete restitution was seen on chest x-ray. Three years later, the patient was scheduled for reconstructive surgery of the midface. Physical examination and laboratory findings at that time were normal. The preoperative chest x-ray, however, demonstrated a large calcified mass adjacent to the anterior wall of the left ventricle (Figure 1). The mass was confirmed by multislice chest CT (Figure 2A) and magnetic resonance imaging (MRI) (Figure 2B through 2D). It was partly filled with floating blood via a small defect of the anterior wall of the left ventricle (arrows in Figure 2A through 2D) while major portions were thrombolized as seen by high signal intensity on black-blood MRI (Figure 2C). Cine MRI (Figure 2D) demonstrated normal thickening of the myocardium, even adjacent to the defect of the myocardial wall. No evidence of coronary artery disease or history of myocardial ischemia was found. Based on these findings, the diagnosis of a traumatic false aneurysm of the anterior left ventricular wall was established.



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Figure 1. Chest x-ray demonstrating a calcified mass adjacent to the left ventricle (arrowheads).



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Figure 2. A, Multislice CT of the chest after intravenous contrast medium administration, arterial phase, and coronal reconstruction. The mass (arrowheads) is partly filled with blood via a small defect of the anterior wall of the left ventricle (arrow), whereas the major portion is thrombolized. The wall is partly calcified. B through D, Corresponding MRI. B, Navigator-gated T2-prepared and fat-suppressed cardiac-triggered 3D gradient echo sequence (TR=7.0 ms, TE=2.2 ms, 1x0.7 mm in-plane resolution, coronal slice orientation). C, Navigator-gated dual-inversion recovery black-blood turbo spin-echo sequence (TR=2 heartbeats, TE=26 ms, 2-chamber view). On this sequence, the thrombolized portion is seen with a bright signal. D, Cine balanced fast field echo (TR=3.2 ms, TE=1.6 ms, 20 heart phases, diastolic frame, 2-chamber view).

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.





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Right arrow CT and MRI