Ventricular Aneurysms

• Congenital left ventricular aneurysm
  • Rare
  • Young, Black adult
    • Submitral type
      • Bulge at left middle / upper cardiac border
    • Subaortic type
      • Small and not visualized
      • Heart greatly enlarged (from aortic insufficiency)
• Acquired left ventricular aneurysm
  • Overwhelming majority are secondary to ischemic heart disease and myocardial infarction
  • May be asymptomatic and well tolerated for years

• True aneurysms
  • Remnants of myocardium within its walls
  • Consequence of transmural myocardial infarction
  • Wide-open neck
  • Rarely rupture
• False aneurysms (pseudoaneurysms)
  • Surrounded by tissue other than myocardium, such as pericardium or pleura
  • Usually the result of localized rupture of the heart
  • Most often involve posterolateral wall of LV
  • They themselves more often rupture than true aneurysms
  • Neck is narrow
  • Often contain clot
• Other causes of ventricular aneurysm
  • Trauma
  • Postoperative
    • Frequently involve the right ventricle
  • Rheumatic heart disease
  • Mycotic aneurysms
• Large majority due to infarction of the left ventricle or ventricular septum
  • Most are on anterior wall
• Anterior inferior part of septum most susceptible and most frequent site of rupture
• Aneurysm frequently contains clot and/or organized thrombus
  • Portions may break away and embolize systemically
• Compatible with a long survival
• May cause
  • LV failure
  • Cardiac arrythmias
  • Embolus
• Majority of false aneurysms are from trauma and post-surgical
• Imaging
  • Conventional chest films can not exclude the presence of a cardiac aneurysm
  • Unusual “bump” on the left side of the heart
    • Most common manifestation on plain film
    • Has a short-radius of curvature
    • Usually in the lower 2/3 of the left ventricular curve

Localized "bump" along mid-left heart border suggests
presence of a left ventricular aneurysm

• DDX
  • Cardiac tumors
  • Enlarged left atrium
  • Pericardial cysts
    • Uncommon on left side
  • Thymomas
• Calcium in wall of aneurysm or thrombus
  • Uncommon
  • Curvilinear
  • Almost always several millimeters below the exterior surface of the heart
  • Infarcts without an aneurysm may calcify

• Localized paradoxical expansion during systole
• Almost all are seen with radionuclide ventriculography
• Left ventriculography is diagnostic

 

 

Cooley and Schreiber-Radiology of the Heart and Great Vessels-3^rd Edition

Dahnert 4^th edition