Imaging Pearls ❯ Cardiac ❯ Pseudoaneurysm
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- “The left ventricle pseudoaneurysm is an anomaly of the left ventricle and is severed and joined with a pocket look. There may be secondary to a myocardial infarction, trauma, or surgical procedure. Sometimes the cause is not found. Complications are heart failure, arrhythmias, vascular embolism, and sudden death. The treatment is surgical only.”
Left ventricle pseudoaneurysm: contribution of multimodality imaging to the diagnosis.
Bertrand Fikahem EM et al.
Case Rep Cardiol. 2014;2014:531929 - “The diagnosis of LVPA is placed in the imaging. The deformation of the cardiac shadow is noted in standard radiography. However, the heart may have a normal appearance. Echocardiography leads to diagnosis, objectifying communication between the left ventricle and the pocket, as in the case we described. The delimitation of contours can be complicated by the configuration of the pocket. Indeed, ultrasound appeared limited in our case, because the pseudoaneurysm communicated with the left ventricle at the tip, and went back under the ribs forward. Transesophageal ultrasound would have a better analysis of the pseudoaneurysm. CT scan has proven to be an indispensable tool in our case, to define the limits of pseudoaneurysm.”
Left ventricle pseudoaneurysm: contribution of multimodality imaging to the diagnosis.
Bertrand Fikahem EM et al.
Case Rep Cardiol. 2014;2014:531929 - “Clinical distinction between true and pseudoaneurysms remains a challenge, but it is important to guide proper management. LV aneurysm describes a saccular protrusion containing the full thickness of the thinned LV wall with scarred myocardium that balloons outward, and akinesia or dyskinesia. Transmural MI is the major underlying cause of LV aneurysm, and usually involves the apical, anterior, or anterolateral wall. Cardiac CT and MR imaging findings include a wide mouth, smooth transition from normal myocardium to thinned, scarred myocardium with delayed enhancement, and akinesia or dyskinesia during systole. Fatty replacement or calcification of the infarcted myocardial wall and thrombus formation may be present.”
Left ventricle pseudoaneurysm: contribution of multimodality imaging to the diagnosis.
Bertrand Fikahem EM et al.
Case Rep Cardiol. 2014;2014:531929 - “LV pseudoaneurysm results from rupture of the LV free wall, contained by an overlying adherent pericardium or scar tissue. Pseudoaneurysm is more commonly seen in inferior and lateral wall segments attributed to MI following left circumflex coronary artery occlusion. Unlike the wide mouth of a true aneurysm, the mouth of a pseudoaneurysm is narrower than the diameter of the aneurysm. Other imaging findings include abrupt transition from normal myocardium to aneurysm, a distinct discontinuity of the ventricular wall, and dyskinesia during both systole and diastole. Pseudoaneurysms have poor prognoses because of the high risk of expansion and rupture, leading to cardiac tamponade, shock, and death. Therefore, they call for urgent surgical repair.”
Left ventricle pseudoaneurysm: contribution of multimodality imaging to the diagnosis.
Bertrand Fikahem EM et al.
Case Rep Cardiol. 2014;2014:531929
- “The left ventricle pseudoaneurysm is an anomaly of the left ventricle and is severed and joined with a pocket look. There may be secondary to a myocardial infarction, trauma, or surgical procedure. Sometimes the cause is not found. Complications are heart failure, arrhythmias, vascular embolism, and sudden death. The treatment is surgical only.”
Left ventricle pseudoaneurysm: contribution of multimodality imaging to the diagnosis.
Bertrand Fikahem EM et al.
Case Rep Cardiol. 2014;2014:531929 - “The diagnosis of LVPA is placed in the imaging. The deformation of the cardiac shadow is noted in standard radiography. However, the heart may have a normal appearance. Echocardiography leads to diagnosis, objectifying communication between the left ventricle and the pocket, as in the case we described. The delimitation of contours can be complicated by the configuration of the pocket. Indeed, ultrasound appeared limited in our case, because the pseudoaneurysm communicated with the left ventricle at the tip, and went back under the ribs forward. Transesophageal ultrasound would have a better analysis of the pseudoaneurysm. CT scan has proven to be an indispensable tool in our case, to define the limits of pseudoaneurysm.”
Left ventricle pseudoaneurysm: contribution of multimodality imaging to the diagnosis.
Bertrand Fikahem EM et al.
Case Rep Cardiol. 2014;2014:531929 - “Clinical distinction between true and pseudoaneurysms remains a challenge, but it is important to guide proper management. LV aneurysm describes a saccular protrusion containing the full thickness of the thinned LV wall with scarred myocardium that balloons outward, and akinesia or dyskinesia. Transmural MI is the major underlying cause of LV aneurysm, and usually involves the apical, anterior, or anterolateral wall. Cardiac CT and MR imaging findings include a wide mouth, smooth transition from normal myocardium to thinned, scarred myocardium with delayed enhancement, and akinesia or dyskinesia during systole. Fatty replacement or calcification of the infarcted myocardial wall and thrombus formation may be present.”
Left ventricle pseudoaneurysm: contribution of multimodality imaging to the diagnosis.
Bertrand Fikahem EM et al.
Case Rep Cardiol. 2014;2014:531929 - “LV pseudoaneurysm results from rupture of the LV free wall, contained by an overlying adherent pericardium or scar tissue. Pseudoaneurysm is more commonly seen in inferior and lateral wall segments attributed to MI following left circumflex coronary artery occlusion. Unlike the wide mouth of a true aneurysm, the mouth of a pseudoaneurysm is narrower than the diameter of the aneurysm. Other imaging findings include abrupt transition from normal myocardium to aneurysm, a distinct discontinuity of the ventricular wall, and dyskinesia during both systole and diastole. Pseudoaneurysms have poor prognoses because of the high risk of expansion and rupture, leading to cardiac tamponade, shock, and death. Therefore, they call for urgent surgical repair.”
Left ventricle pseudoaneurysm: contribution of multimodality imaging to the diagnosis.
Bertrand Fikahem EM et al.
Case Rep Cardiol. 2014;2014:531929
- "Acute aortic injuries are not common in the setting of severe blunt trauma, but lead to significant morbidity and mortality. High- quality MDCT with 2D MPRs and 3D rendering are essential to identify aortic trauma and distinguish anatomic variants and other forms of aortic pathology from an acute injury. Misinterpretation of mimics of acute aortic injury can lead to unnecessary arteriography and thoracic surgery. Since most traumatic injuries occur in the distal arch, radiologists must be cognizant of the range of appearances of variants related to the ductus diverticulum. Cinematic rendering (CR) is a new 3D post-processing tool that provides even greater anatomic detail than traditional volume rendering."
MDCT of ductus diverticulum: 3D cinematic rendering to enhance understanding of anatomic configuration and avoid misinterpretation as traumatic aortic injury
Steven P. Rowe, Pamela T. Johnson, Elliot K. Fishman
Emergency Radiology (2018) 25:209–213 - "However, not all abnormalities of the aorta indicate an acute process, and multiple pitfalls that can mimic acute aortic injury have been described. Among these is the ductus diverticulum—a remnant of the ductus arteriosus that arises from the lesser curvature of the aortic arch, which can be mistaken for a traumatic aortic pseudoaneurysm, dissection, or incomplete rupture. The distal aortic arch, and in particular the undersurface, is the most common location for acute traumatic aortic injury.
MDCT of ductus diverticulum: 3D cinematic rendering to enhance understanding of anatomic configuration and avoid misinterpretation as traumatic aortic injury
Steven P. Rowe, Pamela T. Johnson, Elliot K. Fishman
Emergency Radiology (2018) 25:209–213
- “In most instances, surgery is indicated for asymptomatic patients without another underlying cardiovascular condition or disease, with aneurysms measuring greater than or equal to 5.5 cm. The risk of aortic dissection or rupture at diameters above 5.5 cm is generally perceived to exceed the risk of operation, warranting intervention. In patients with evidence of rapid aortic growth (>0.5–1 cm per year), elective surgical interven- tion should also be considered even if absolute size criteria have not been met.”
Pre- and Postoperative Imaging of the Aortic Root Hanneman K et al. RadioGraphics 2016; 36:19-37 - “In the surgical context, the term pseudoaneurym is applied to any extravascular or extragraft blood-perfused space typically arising from a site of anastomosis, can- nulation, or arteriotomy, arising from an artery, graft, or the heart (for example, the infravalvular region of the left ventricular outflow tract).”
Pre- and Postoperative Imaging of the Aortic Root Hanneman K et al. RadioGraphics 2016; 36:19-37 - “A pseudoaneurysm is defined as a blood-filled space beyond the expected contours of an artery due to a partial or complete breach of the arterial wall, with a persistent communication to the bloodstream. Pathologically, a pseudoaneurysm may be contained by some, but not all, layers of the original arterial wall (for example, a traumatic aortic pseudoaneurysm may be contained by an intact adventitial layer), or it may be contained by surrounding tissues alone.”
Pre- and Postoperative Imaging of the Aortic Root Hanneman K et al. RadioGraphics 2016; 36:19-37 - “Hyperattenuating felt pledgets may be mistaken for a pseudoaneurysm on contrast-enhanced CT angiograms, warranting careful evaluation of non- enhanced images to confirm the presence of the high-attenuation (polytetrafluoroethylene) surgical material. In comparison, pseudoaneurysms are usually iso- or hypoattenuating relative to surrounding tissue, and isoattenuating with the blood pool, on noncontrast CT images.”
Pre- and Postoperative Imaging of the Aortic Root Hanneman K et al. RadioGraphics 2016; 36:19-37
- “Coronary artery anastomotic dehiscence is a rare complication following aortic root repair in Marfan's disease. In this patient who presented several years after surgery with mediastinal and chest wall hematoma, gated IV contrast enhanced cardiac CT was able to noninvasively localize left main coronary artery anastomotic dehiscence as the source of bleeding.”
Dehiscence of coronary artery graft presenting as a right breast mass
Samet JD, Johnson PT, Fishman EK Cardiovasc Comput Tomogr. 2011 May-Jun;5(3):180-2 - “Currently, there are two main types of surgical correction, the Bentall procedure or composite graft with aortic valve replacement, and aortic valve-sparing. Both procedures have low operative risk. Since a prosthetic valve is used in the Bentall procedure, it is associated with higher rates of thromboembolism, and thus these patients must be anti-coagulated. The valve-sparing procedure has lower rates of thromboembolism given the native aortic valve, but re-operation rates have been shown to be higher than the Bentall procedure. Patients who undergo the Bentall procedure have lower late survival rates, but this is likely due to its preferred use in emergent higher risk cases.”
Dehiscence of coronary artery graft presenting as a right breast mass
Samet JD, Johnson PT, Fishman EK Cardiovasc Comput Tomogr. 2011 May-Jun;5(3):180-2