A Multimodality Imaging Evaluation of a Huge Postsurgical Cardiac Pseudoaneurysm

We present a multimodality imaging study of a rare case of postsurgical chronically evolved pseudoaneurysm with a possible rupture buffered by the huge thrombus.

A patient known for previous late presentation myocardial infarction complicated by shock and ventricular septal defect and treated with surgical repair and triple coronary artery bypass grafting, was directed to our hospital for severe mitral regurgitation. Computed tomography, cardiac magnetic resonance, and echocardiography, in a multimodality approach, revealed a huge postsurgical cardiac pseudoaneurysm, with an extensive thrombus and the native pericardium not perfectly distinguishable from pseudoaneurysm tissue or surgical patch.

All the tissue characteristics were supporting a chronically evolved pseudoaneurysm following detachment of the ventricular surgical patch, with a possible rupture buffered by the huge floating thrombus, complicated by ischemic stroke and severe mitral regurgitation.

Computed tomography and cardiac magnetic resonance images can provide precise details for interventional planning, cardiac volume and function, and tissue characterization. Multimodality imaging could be essential for evaluation of complex cases.