Transthoracic echocardiography—the overlooked sentinel for pseudoaneurysm: a case report

Left ventricular pseudoaneurysm (LVP) is considered a surgical emergency; however, diagnosis is often delayed owing to its often-insidious presentation.

We present a case of a patient with non-specific symptoms who was found to have a massive LVP. Retrospective review of a transthoracic echocardiogram (TTE) and single photon emission computed tomography (SPECT) with computed tomography (CT) attenuation correction 2 years before this presentation demonstrates a similarly sized LVP that was initially undetected, as it mimicked normal anatomy.

Common, readily available testing after myocardial infarction, such as TTE and SPECT with CT attenuation correction, are not traditionally utilized for LVP diagnosis because of their low sensitivity. This case demonstrates that these tests may serve a complementary role, providing an opportunity to quickly detect abnormalities and expedite definitive testing. However, cognizance of at-risk patients by cardiac imagers is paramount to increase detection.