CTICasesLeft Ventricular Pseudoaneurysm after Cardiac Surgery
Imaging findings
A radiograph shows a coronary stent and a cardiac contour bump that has enlarged compared with a study from six years earlier. Recent CT reveals a large, irregular left ventricular pseudoaneurysm with a narrow neck, contrast tracking into the myocardium along the inferolateral wall, and evidence of a right ventricular outflow tract patch repair from prior cardiac surgery, with associated patch-like tissue near the LV apex and some calcification.
Key takeaways
This markedly atypical, extensive pseudoaneurysm likely relates to breakdown of a prior surgical repair, possibly a patched ventricular septal defect or an infarct-related patch, at a site of deficient myocardium, rather than a straightforward anterior wall aneurysm producing a simple bump on the cardiac silhouette. Any patient with an abnormal cardiac contour and a history of prior cardiac surgery should prompt consideration of a pseudoaneurysm, and the narrow neck on CT is a key discriminator from a true aneurysm.
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