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(Circulation. 2008;118:2111-2114.)
© 2008 American Heart Association, Inc.

Images in Cardiovascular Medicine

Right Ventricular False Aneurysm After Unrecognized Myocardial Infarction 28 Years Previously

Hannibal Baccouche, MD; Adrian Ursulescu, MD; Ali Yilmaz, MD; German Ott, MD; Karin Klingel, MD; Manfred Zehender, MD; Heiko Mahrholdt, MD

From the Departments of Cardiology (H.B., A.Y., H.M.), Cardiovascular Surgery (A.U.), and Pathology (G.O.), Robert-Bosch-Medical Center, Stuttgart, Germany; Department of Molecular Pathology (K.K.), University of Tuebingen, Tuebingen, Germany; and Department of Cardiology (M.Z.), Albert-Ludwigs-University Freiburg, Freiburg, Germany.

Correspondence to Heiko Mahrholdt, MD, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany. E-mail heiko.mahrholdt@rbk.de

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 74-year-old woman underwent an abdominal computed tomography scan for work-up of unclear recurring abdominal discomfort because abdominal ultrasound had not been diagnostic on account of a poor acoustic window and obesity (body mass index 31). Computed tomography did not detect any abdominal pathology but revealed an unclear mass located at a left anterior position on the cranial side of the diaphragm, most likely related to the apical portions of the heart (Figure 1). Thus, the patient was referred to our hospital for further cardiological work-up.

View larger version (89K):   Figure 1. Abdominal computed tomography scan with oral contrast agent. The unclear mass, located at a left anterior position on the cranial side of the diaphragm and related to the apical portions of the heart, is indicated by the arrowhead. Panels I to IV appear in cranio-caudal order.

Interestingly, the patient had been hospitalized twice at intervals of 4 months because of 2 episodes of severe chest pain 28 years previously, but no diagnosis could be made at that time. Routine ECG on admission revealed an abnormal electrical axis as well as high R-wave amplitudes in V2 and V3 (Figure 2). Consequently, additional right ventricular leads were obtained, demonstrating discrete ST-segment elevations (rV1 to rV4) and negative T waves (rV2 to rV6) (Figure 3), indicating possible right ventricular pathology. Because transthoracic echocardiography could not reveal any right ventricular abnormality (Figure 4 and online-only Data Supplement), the patient was referred to cardiovascular magnetic resonance (CMR) imaging (1.5 Tesla . . . [Full Text of this Article]