Left ventricular Dissecting Pseudoaneurysm with Extensive Intramural
Course: Management Challenges
A 69-year-old female presented to the emergency department with chest
pain and EKG changes consistent with anterior STEMI. Left heart
catheterization revealed multi-vessel CAD. She was referred for a CABG.
Transthoracic echocardiography (TTE) with contrast raised concerns for
apical pseudoaneurysm (Image 1). Cardiac computed tomography (CT)
confirmed the presence of a multi-lobular dissecting pseudoaneurysm and
extensive pericardial thickening (Images 3 and 4). This was confirmed at
surgery, and she underwent partial pericardiectomy. Repair of the
defects was deemed too high risk and adhesion prevented the insertion of
any grafts. She subsequently underwent percutaneous revascularization.