CTICasesMitral-Aortic Intervalvular Fibrosa Pseudoaneurysm
Imaging findings
Chest CT angiography in a patient with a history of partially treated Streptococcus pneumoniae bacteremia and meningitis demonstrates a localized, contrast-filled pseudoaneurysm/abscess cavity situated in the posterior aspect of the aortic root, specifically within the mitral-aortic intervalvular fibrosa (MAIVF) immediately below the non-coronary cusp. The left ventricle is dilated, and there is associated pulmonary edema.
Key takeaways
Pseudoaneurysm or abscess of the mitral-aortic intervalvular fibrosa (MAIVF) is a serious complication of infective endocarditis. The MAIVF is a thin, fibrous region between the aortic valve and the anterior mitral leaflet that is relatively avascular, making it highly vulnerable to infection and rupture. It presents as a pulsatile pouch on CT/echo that can compress adjacent structures or rupture into the pericardium or left atrium.
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