Left ventricular pseudoaneurysm by cardiac CT angiography

Although left ventricular (LV) pseudoaneurysm is seen infrequently, it should be recognized and distinguished from the common type of left ventricular aneurysm. The diagnosis can be difficult and the lesions are prone to rupture, thus the condition is associated with a high rate of morbidity and mortality. LV pseudoaneurysms are the result of a contained rupture of the free wall of the myocardium, with the containment being provided by adherent pericardium or scar tissue. Among patients dying of infarction, 17% have been found to have ruptured the heart through the infarcted area. Rupture of the free wall is four to five times more common than septal rupture and is usually immediately fatal. We present images of a LV pseudoaneurysm in a patient with a past history of coronary bypass grafting who underwent computed tomographic angiography for evaluation of his bypass vessels.