Cardiac aneurysm

Cardiac aneurysm

Characteristics

  1. A true aneurysm is a circumscribed non-contractile outpouching of the left ventricle.
  2. Although there is a very rare congenital form, the majority occur as a complication of myocardial infarction. It rarely ruptures, but patients are at risk of arrhythmias and thromboembolic events that occur from clot formation within the aneurysm.
  3. A pseudoaneurysm, or false cardiac aneurysm, occurs acutely following trauma or a myocardial infarction, with a focal left ventricular rupture, localised haematoma and a high risk of delayed rupture and death.

Clinical features

  1. Most are asymptomatic and go without any problems.
  2. There is an association with arrhythmias, thromboembolic events and rarely cardiac failure.

Radiological features

  1. CXR – localised bulge in the left heart border. There is often a thin peripheral rim of calcification within the ventricular wall.
  2. Echocardiography – paradoxical movement of the left ventricular wall in systole is diagnostic. The aneurysm may contain thrombus.

Differential diagnosis

  1. Previous TB pericarditis, with a background of ischaemic heart disease, can have a very similar appearance on a frontal CXR. A lateral viewmay show absence of the localised posterior LV aneurysm. Echocardiography allows accurate characterisation of both pathologies.

Management

  1. No active treatment necessary.
  2. Occasionally anticoagulation for mural thrombus formation is needed.

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