A Multimodal Imaging Approach to Left Ventricular Aneurysms, Pseudoaneurysms, and Diverticula

The differential diagnosis of aneurysmal dilation of the ventricular wall includes aneurysm, pseudoaneurysm, and diverticulum. Aneurysm and pseudoaneurysm are associated with myocardial ischemia, whereas diverticulum is a congenital anomaly. These conditions can be differentiated using transthoracic echocardiography, and accurate differentiation is crucial because pseudoaneurysms carry a high risk of rupture and require urgent surgical intervention. We describe 3 cases of left ventricular outpouchings with distinct etiologies and clinical implications. The first case involved a true inferior wall aneurysm with thrombus in a patient presenting with heart failure, which was successfully managed with surgical resection. The second case featured multiple pseudoaneurysms and a ventricular septal defect after anterior myocardial infarction complicated by cardiogenic shock, requiring veno-arterial extracorporeal membrane oxygenation, revascularization, and surgical repair. The third case was an incidental finding of a large inferolateral diverticulum in a minimally symptomatic patient. These cases illustrate the diverse presentations of left ventricular outpouchings and underscore the importance of accurate diagnosis and tailored management strategies.