Abstract 4136516: Intraventricular pseudoaneurysm: A diagnosis with high mortality that demands a good eye

Abstract

Traumatic left ventricular (LV) pseudoaneurysms (PSA) are rare, life-threatening complications of blunt chest trauma and the management is heavily reliant on early identification and diagnosis. A healthy 55-year-old female presented after blunt chest trauma from a car accident. Bedside echocardiogram revealed a mid-septal LV discontinuity with myocardial outpouching. Lab work was significant for high sensitivity troponin of 22,000 ng/L which peaked at 24,000 in 5 hours. ECG revealed normal sinus rhythm with a QRS duration of 102ms. No ventricular ectopy was detected. Transthoracic echocardiograph (TTE) using echo contrast agent and computed tomography (CT) scan confirmed the intraventricular pseudoaneurysm (Fig 1-A&B). A transesophageal echocardiogram (TEE) showed an intact PSA at 3.7 x 2.5 cm LV PSA with a 5mm neck extending from the mid septum superiorly into the right ventricle (RV) with no Doppler evidence of rupture or shunt (Fig 2). With cardiology and cardiac surgery shared decision making, conservative therapy was elected in the setting of polytrauma and hemodynamic stability. Serial TTEs showed stable size and appearance of the PSA during her month long hospitalization. Cardiac magnetic resonance imaging (cMRI) 7 months later showed significant improvement in the PSA size to 0.3 cm 2 and extensive myocardial remodeling (Fig 1-C). LV septal PSA is rare following blunt chest trauma, and it confers a considerable risk of rupture with the highest risk occurring within 3 months of formation. Untreated PSA presents with risks including thromboembolism, infection, and arrhythmia. Multimodal cardiac imaging is paramount for diagnosis and surveillance. There are no guidelines for serial monitoring in hemodynamically stable patients and an individualized approach should be taken. In this patient TTE, TEE, and CT imaging modalities were utilized. Our patient progressed without complication following conservative management with shrinking and scarring of the aneurysm characterized by the cMRI.