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Il Giornale Italiano di Radiologia Medica 2019 Gennaio-Febbraio;6(1):31-7

DOI: 10.23736/S2283-8376.19.00151-7

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English, Italian

CT angiography semeiotics of the pseudoaneurysm of the left ventricle: description of two cases

Antonio PIERRO 1 , Savino CILLA 2, Anna M. TELESCA 1, Carlo M. DE FILIPPO 3, Antonio MARRAZZO 4, Consolato GULLÌ 4, Giuseppina SALLUSTIO 1

1 Department of Radiology, “Giovanni Paolo II” Foundation, Sacred Heart Catholic University, Campobasso, Italy; 2 Unit of Medical Physics, “Giovanni Paolo II” Foundation, Sacred Heart Catholic University, Campobasso, Italy; 3 Department of Cardiovascular Surgery, “Giovanni Paolo II” Foundation, Sacred Heart Catholic University, Campobasso, Italy; 4 Department of Bioimaging and Radiological Sciences, Institute of Radiology, Sacred Heart Catholic University, Rome, Italy


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Pseudoaneurysm of the left ventricle (LVP) originates when the rupture of the cardiac wall is contained by adherent pericardium or scar tissue; LVP is a rare condition because, generally, the wall breach leads to a massive fatal cardiac tamponade. LVP is often asymptomatic and found incidentally; nevertheless, clinically, it can lead to syncope, ventricular arrhythmias, heart failure, severe angina or systemic embolization. It is a rare complication of a myocardial infarction (MI) and, due to the high risk of rupture, it is a cardiac surgery emergency. Distinction between true and false aneurysm is always a challenge, with any imaging modality. Typically the wall of the true aneurysm contains myocardium whereas the pseudoaneurysm wall consists only of organized hematoma and pericardium and lacks of myocardial and endocardial elements. LVPs typically have a narrow neck, are frequently located in the posterior and lateral wall and form an acute angle with the ventricular wall; conversely, the true aneurysms, are observed more often in the anterior wall and in the apex, have a large neck and form an obtuse angle with the ventricular wall. In this paper we present two cases of patients who came to our observation following the onset of cardio-respiratory symptoms. Imaging, in particular the angio-computed tomography (CT), allowed the identification of an LVP in both cases. The aim of our work was therefore to describe the angio-CT semeiotic of the pseudoaneurysm of the left ventricle, a fundamental tool to perform a correct diagnosis.


KEY WORDS: Heart ventricles - Aneurysm, false - Aneurysm - Computed tomography angiography - Myocardial infarction

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