PMC4640425_01
(A) Frontal radiograph of the chest demonstrates left retrocardiac opacity. (B) Parasternal long axis view shows large fluid-filled structure (PAn) along the LA. (C) Axial image from a CT angiogram of the heart demonstrates a LV pseudoaneurysm (PAn). The neck of the pseudoaneurysm is close to the mitral valve (MV); however, the MV is not involved. (D) Oblique sagittal reformatted image from a CT angiogram of the heart demonstrates dissection (white arrow) into the myocardium of the inferior wall of the left ventricle (LV) adjacent to the neck of the pseudoaneurysm (PAn). (E) 3D reformatted image from a CT angiogram of the heart demonstrates LV pseudoaneurysm (PAn) involving the inferior wall and extending into posterolateral wall. (F) Volume-rendered image from a CT angiogram of the heart again demonstrates LV pseudoaneurysm (PAn).. Abbreviations: LA, left atrium; Ao, aorta; LV, left ventricle.
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Chest X-ray on admission revealed retrocardiac opacity (Fig. 1A). On transthoracic echocardiogram, a large 6.1 cm fluid-filled structure was observed along the LA, which compressed it during systole, and some evidence of flow from the LV into the structure (Fig. 1B). The pseudoaneurysm measured 9 cm in its largest diameter with a 3 cm neck (Fig. 1C). There was evidence of dissection into the myocardium of the inferior wall of the LV adjacent to the neck of the pseudoaneurysm (Fig. 1D). 3D reconstructions and volume-rendered images showed the anatomic relationship of the pseudoaneurysm to the cardiac structures (Fig. 1E and F).