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Abnormal Color Flow Signal Traversing the Myocardial Wall: Not Everything is What it Appears to Be
Kathy Edelman1, Angel López-Candales2
1Division of Cardiovascular Medicine, University of Pittsburgh Cardiovascular Institute, Pittsburgh, PA, USA.
Insights
This case study highlights how advanced echocardiography successfully diagnosed a cardiac pseudoaneurysm, a rare complication of myocardial infarction. Surgical repair of the pseudoaneurysm and coronary artery bypass grafting were performed.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Cardiac Surgery
Background:
- Acute myocardial infarction can lead to rare but serious cardiac complications.
- Accurate diagnosis is crucial for effective management of post-infarction cardiac abnormalities.
Observation:
- A patient presented with an acute myocardial infarction and an abnormal echocardiographic signal initially suspected as a ventricular septal defect.
- The abnormal signal originated from a large inferior aneurysm, traversing the myocardial wall.
Findings:
- Modified echocardiographic views and contrast injections (agitated saline and Definity®) definitively identified the abnormality as a cardiac pseudoaneurysm.
- Echocardiography alone provided sufficient diagnostic information, obviating the need for further testing.
Implications:
- This case demonstrates the diagnostic power of advanced echocardiography in identifying complex cardiac pseudoaneurysms.
- Successful surgical management involving pseudoaneurysm repair and coronary artery bypass grafting is feasible and effective.
Abstract:
A case of a patient presenting with an acute myocardial infarction is presented. A transthoracic echocardiographic examination revealed an abnormal color flow signal that traversed the myocardial wall from a large inferior aneurysm and initially considered to be a ventricular septal defect. However, further echocardiographic manipulation utilizing modified views along with sequential injections of both agitated saline and Definity® proved very useful to identify a pseudoaneurysm. There was no further need for any other diagnostic test, and the patient was treated surgically, undergoing successful repair of the pseudoaneurysm as well as coronary artery bypass grafting of the left coronary artery.