Figure 1
Teaching Case
SectionCardiovascular
Case TypeClinical Cases
AuthorsH J Williams
Connected authors
65 years, male
A patient with a past history of anterolateral myocardial infarction attended for routine chest x-ray for insurance purposes. He was asymptomatic and physical examination was apparently unremarkable. His chest x-ray showed bulging of the anterior and left heart border with associated curvilinear peripheral calcification
Left ventricular aneurysm
A patient with a past history of anterolateral myocardial infarction attended for routine chest x-ray for insurance purposes. He was asymptomatic and physical examination was apparently unremarkable. His chest x-ray showed bulging of the anterior and left heart border with associated curvilinear peripheral calcification characteristic of left ventricular aneurysm.
Left ventricular (LV) aneurysm develops in a small percentage of patients with a large anteroseptal myocardial infarct. Weakening of the myocardial wall permits the development of a local bulge at the site of the infarct. Pathologically there is a large thin-walled sac bulging from the lumen and the external surface of the heart, usually clearly demarcated from normal myocardium. Plain radiographic findings can be normal, but the aneurysm can be appreciated on the chest x-ray as a 'bulge' in the contour of the left heart border. Curvilinear peripheral calcification is an infrequent but important sign that occurs only after several years.
Many patients with LV aneurysm are asymptomatic, but patients may present with left ventricular failure or angina refractory to medical treatment. Occasionally recurrent ventricular tachycardias or systemic embolisation can occur due to LV aneurysm. Clinical examination may reveal a sustained apical impulse and an atrial beat. Persistent elevation of ST segments is seen on the ECG. LV aneurysm may occur inferiorly and posteriorly but this is less common, the physical signs are less obvious and it is usually associated with mitral regurgitation. The diagnosis is usually confirmed by two-dimensional echocardiography, MUGA scan, left ventricular angiography, CT or MR of the heart. Symptomatic patients are investigated with a view to LV aneurysmectomy if their residual contractile function is adequate and if medical therapy fails to control symptoms.
References
[1] Swanton RH. Coronary artery disease. In Swanton RH. Pocket consultant: cardiology, Fourth edition. Blackwell Science Ltd, Oxford, pp 137-218 (1998).
[2]
Eisenberg RL. Cardiovascular patterns.
In Eisenberg RL. Clinical imaging, an atlas of differential diagnosis, Third edition. Lippincott Williams and Wilkins, Philadelphia, pp 209-76 (1997).
[3] Miller SW. Ischaemic heart disease. In Miller SW. Cardiac radiology: the requisites. Mosby, St Louis, pp 199-246 (1996).
[4] Raphael M J. Ischaemic heart disease. In Grainger RG, Allison DJ (eds) Grainger and Allison's diagnostic radiology, a textbook of medical imaging, Volume 1, Third edition. Churchill Livingstone, London, pp 753-71 (1997).
Case information
| URL: | https://www.eurorad.org/case/1496 |
| DOI: | 10.1594/EURORAD/CASE.1496 |
| ISSN: | 1563-4086 |
