Characterizing a Left Ventricular Pseudoaneurysm With Photon-Counting Detector CT
Abstract
Background: Ventricular pseudoaneurysms are a rare but potentially fatal complication of myocardial infarction. Accurate differentiation from true aneurysms is crucial given the risk of rupture.
Case summary: A 57-year-old woman presented with acute chest pain and progressive dyspnea. Electrocardiography showed signs of chronic infarction, while echocardiography revealed an aneurysmal structure and pericardial effusion. Photon-counting detector computed tomography (PCD-CT) was able to identify a large inferoseptal pseudoaneurysm with mural thrombus, occlusion of the right coronary artery, myocardial fibrosis consistent with infarction, and pericardial thickening suggesting concomitant pericarditis. Cardiac magnetic resonance imaging confirmed the PCD-CT findings and showed no signs of edema, indicating that the infarction was chronic. The patient subsequently underwent successful surgical aneurysmectomy.
Discussion: This case highlights the diagnostic capabilities of PCD-CT in cardiac imaging, including late iodine enhancement and extracellular volume measurements to detect myocardial fibrosis.
Take-home message: PCD-CT allows evaluation of cardiac anatomy, coronary arteries, cardiac function, and myocardial tissue as a one-stop shop, even in a complex surgical case.
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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