Left Ventricular Pseudoaneurysm
Clinical Role of Cardiovascular Magnetic Resonance Imaging
A 66-year-old woman (169 cm, 70 kg) with known 3-vessel coronary artery disease, a mildly reduced left ventricular (LV) ejection fraction (55% by echocardiography), and a history of anterior myocardial infarction (1997) underwent routine echocardiography that showed a thrombus-like, mobile formation at the apex. Transthoracic and transesophageal echocardiography did not clarify the situation. Consequently, contrast-enhanced cardiac MRI was performed to evaluate LV function, depict size of the myocardial infarction, and differentiate apical pathology using a 1.5-T scanner (Siemens Magnetom Sonata Maesto Class).
Horizontal long-axis breath-hold cine-MR (TRUE-Fisp) showed akinetic apical and septal segments with apical wall thinning and no typical myocardium. Between the LV chamber and the apex, a membranous border with signs of turbulence (“voids”) indicates a communication between the left ventricle and a “chronic” pseudoaneurysm (Figures 1 and 2⇓). T1-weighted (Segmented Inversion recovery TurboFLASH) image acquisition showed transmural scarring in the anteroapical segments (Figure 3). There were no signs of thrombus formation.
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.
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