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(Circulation. 2004;109:e222-e223.)
© 2004 American Heart Association, Inc.

Images in Cardiovascular Medicine

Left Ventricular Pseudoaneurysm

Clinical Role of Cardiovascular Magnetic Resonance Imaging

G.O. Kerkhoff, MD; C. Höfs, MD; N. Roer, MD; G. Albes, MD; A. Lehner, MD; B. Koslowski, MD; D. Kühne, MD; T. Budde, MD

From the Department of Internal Medicine I and Cardiology (G.O.K., C.H., T.B.) and Department of Radiology and Neuroradiology (N.R., G.A., D.K.), Alfried Krupp Krankenhaus, and Department of Internal Medicine, Cardiology Clinic, Kliniken Essen-Sued (A.L., B.K.), Essen, Germany.

Correspondence to Gert O. Kerkhoff, MD, EC, Department of Internal Medicine I and Cardiology, Alfried Krupp Krankenhaus, Essen, Alfried Krupp Strasse 21, 45117 Essen, Germany.

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.

View larger version (104K): [in this window] [in a new window]   Figure 1. Long-axis cardiac MR image (4-chamber view) demonstrating communication between the left ventricle and the apical chronic pseudoaneurysm.

View larger version (130K): [in this window] [in a new window]   Figure 2. Long-axis cardiac MR images (LV outflow tract) demonstrating communication between the left ventricle and the apical chronic pseudoaneurysm.

View larger version (109K): [in this window] [in a new window]   Figure 3. Long-axis postcontrast late enhancement MR image shows transmural scarring of the apex and a 50% transmural involvement of the anteroseptal region with no signs of additional thrombus formation.

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.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kerkhoff, G.O. Articles by Budde, T. Search for Related Content PubMed PubMed Citation Articles by Kerkhoff, G.O. Articles by Budde, T. Pubmed/NCBI databases Medline Plus Health Information MRI Scans Related Collections CT and MRI Chronic ischemic heart disease