Subacute giant left ventricular pseudoaneurysm mimicking pneumonia.

Abstract

Case report A 79-year-old housewife experienced sudden-onset chest tightness and was diagnosed with an inferoposterior wall myocardial infarction (MI). Coronary angiography showed two-vessel coronary artery disease with lesions of 70–80 % stenosis of the proximal left anterior artery (LAD) and total occlusion of the proximal left circumflex artery (LCX). An emergent percutaneous coronary intervention (PCI) was performed for the culprit lesion of the proximal LCX. It took about 6 h from chest tightness to revascularization. Transthoracic echocardiogram (TTE) showed impaired left ventricular performance (LVP), with mild mitral regurgitation. Two weeks later, a chest radiography showed progressive left lower lung consolidation. Uncontrolled pneumonia was resent initially; however, symptoms of advanced heart failure progressed. Therefore, PCI was performed for the lesion of the proximal LAD. Unfortunately, symptoms of heart failure did not improve after total coronary revascularization and optimal medical treatment. The anteroposterior view showed delayed regression of the left lower lung consolidation (Fig. 1a), and the lateral view showed a giant bulging mass in the posterior wall of the heart (Fig. 1b). Follow-up TTE showed poor LVP (LV ejection fraction: 36 %), posterior and lateral wall near akinesia, and moderate mitral regurgitation. A huge pseudoaneurysm (diameter 5.5 cm) of the inferoposterior aspect of the lateral wall of the LV (Fig. 2a, b; supplemental Fig. S1) presented with a narrow base and was contained by the pericardium. Chest computed tomography showed a single 7.4 9 8.0-cm lobulated pseudoaneurysm abutting the posterior wall of the LV (Fig. 2c). The surgical intervention performed was concomitant LV repair and mitral valve repair. Then, the patient died due to uncontrolled heart failure one month after surgery.