Left ventricular pseudoaneurysm versus aneurysm a diagnosis dilemma

Abstract

Free wall rupture of the left ventricle (LV) is a rare but life-threatening complication of acute myocardial infaction. Very rarely such rupture may be contained by the adhering pericardium creating a pseudoaneurysm. This condition warrants for an emergency surgery. Left ventricular aneurysm is the discrete thinning of the ventricular wall (<5 mm) with akinetic or dyskinetic wall motion causing an out-pouching of the ventricle. Given the propensity for pseudoaneurysms to rupture leading to cardiac tamponade, shock, and death, compared with a more benign natural history for true aneurysms, accurate diagnosis of these conditions is important. True aneurysm, usually, calls for an elective surgery. Clinically differentiating the two conditions remains a challenge. We report the case of a patient with LV pseudoaneurysm, initially diagnosed as true aneurysm at our institution. We have attempted to review the existing literature and discussed the characteristic findings of each entity.

Rupture of Left Ventricular Pseudoaneurysm: A Tragedy that Must Be Avoided

“…Those with interventricular septal rupture, papillary muscle rupture, or with pseudoaneurysm, may present from abrupt hypotension, precordial pain and dyspnea to less typical symptoms, such as malaise, nausea and vomiting.¹ Thus, considering the clinical evolution of the patient and the degree of reperfusion obtained with treatment, hospital discharge should be delayed, allowing Differentiating true aneurysm from pseudoaneurysm is still a major challenge. 3 The basic difference between them is that in true aneurysm, the ventricular wall is intact and there is bulging of all portions of the unbroken myocardium and the adjacent scar tissue (myocardial fibrosis). 3 The pseudoaneurysm is formed by a rupture of the ventricular wall in the area of transmural infarction, which is contained by pericardial adhesions, leading to the formation of a localized hemopericardium.…”

“…3 The basic difference between them is that in true aneurysm, the ventricular wall is intact and there is bulging of all portions of the unbroken myocardium and the adjacent scar tissue (myocardial fibrosis). 3 The pseudoaneurysm is formed by a rupture of the ventricular wall in the area of transmural infarction, which is contained by pericardial adhesions, leading to the formation of a localized hemopericardium. 1,3,4 Therefore, the wall of the false aneurysm is fragile, as it is only formed by layers of fibrous tissue collagen of the pericardium, associated or not with thrombi.…”

“…3 The pseudoaneurysm is formed by a rupture of the ventricular wall in the area of transmural infarction, which is contained by pericardial adhesions, leading to the formation of a localized hemopericardium. 1,3,4 Therefore, the wall of the false aneurysm is fragile, as it is only formed by layers of fibrous tissue collagen of the pericardium, associated or not with thrombi. 3,5 While true aneurysm can hardly break, pseudoaneurysm is prone to expansion and rupture, so early corrective surgery should be recommended for all patients.…”

Post-Traumatic Giant Left Ventricular Pseudoaneurysm: a Multimedia Presentation

“…Left ventricular pseudoaneurysms (LVP) form in the presence of a cardiac rupture contained by surrounding structures, like the pericardium or scar tissue [1] . Thus, unlikely true aneurysms, a LVP contains no endocardium or myocardium, being more propense to ruptures [2][3][4] . Trauma is a rare cause, given the high mortality in this scenario [5] .…”

Multi-Image Studies of Atypical Location of Ventricular Aneurysms and Survival: Clinical Cases Series

“…organizing thrombus and hematoma, while the true LV aneurysm is an area of thinned myocardium that is dyskinetic and involves the full thickness of the wall[15].In the literature, there is one case of 59-years-old female with cardiovascular Characteristics of CMR to differentiate between true aneurysm from pseudoaneurysm (Sharma, A., et al Cardiovasc Diagn Ther. 2015; 5(6): 464-470).…”