Chest
Volume 111, Issue 5, May 1997, Pages 1403-1409
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Reviews
Distinguishing Left Ventricular Aneurysm From Pseudoaneurysm: A Review of the Literature

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A postmyocardial infarction left ventricular pseudoaneurysm occurs when a rupture of the ventricular free wall is contained by overlying, adherent pericardium. A postinfarction aneurysm, in contrast, is caused by scar formation resulting in thinning of the myocardium. Although the usual treatment for patients with pseudoaneurysm is urgent surgical repair, the imaging characteristics of pseudoaneurysm and aneurysm, for which treatment is more conservative, are quite similar. The literature on the natural history and imaging characteristics of the two entities is reviewed, and an approach to distinguishing between the two entities is proposed.

Section snippets

DEMONSTRATIVE CASE

A 69-year-old patient with a history of coronary artery disease presented with symptoms of progressive chest pain. He had presented 10 years prior with angina and had undergone coronary artery bypass grafting with a left internal mammary artery to the left anterior descending coronary artery. ECG revealed high lateral ST elevation with small lateral Q waves. He underwent a coronary angiographic examination that revealed a patent left internal mammary artery graft to the left anterior descending

Natural History of Patients With a Pseudoaneurysm

In 1967, Roberts and Morrow4 reported the case of a patient with and reviewed the literature on postinfarction ventricular pseudoaneurysm. They noted six prior reports, the earliest by Corvisart in 1797.5, 6, 7, 8, 9, 10 The patient described by Roberts and Morrow had a large aneurysmal cavity that produced both New York Heart Association class IV heart failure and embolic events, resulting in a decision to resect. A pseudoaneurysm was found at the time of surgery which was repaired, although

Contrast Ventriculography

The first report (to our knowledge) of the successful surgical repair of pseudoaneurysms was published in 1957 by Smith et al.24 In their patients, the diagnosis was made by a technique called direct cardioangiography, which required a needle to be placed in the left atrium percutaneously so that contrast could be injected manually. To our knowledge, there has been no prospective trial of the use of modern ventriculography in distinguishing aneurysms from pseudoaneurysms. There have been two

CONCLUSIONS

At present and to our knowledge, there is no definitive noninvasive test to make the distinction between the two entities on gross inspection. However, the pathologic feature that distinguishes between the two is that a true aneurysm contains elements of myocardium, while a pseudoaneurysm does not. While the differentiation of myocardium vs thrombus lining a pseudoaneurysm cavity may be very difficult to discern with conventional imaging techniques, future advances in tissue characterization

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