Project description:Penetrating injuries of the thorax and abdomen, such as gunshot and stabbing, are rare in children. We present the case of a pediatric patient with a history of remote gunshot injury presenting with a late aneurysm in the left ventricle. (Level of Difficulty: Intermediate.).
Project description:Left ventricular pseudoaneurysm is a potentially life-threatening complication of acute myocardial infarction. Timely diagnosis is crucial to improve the patient's prognosis. We describe a multimodality diagnostic approach with emphasis on cardiac magnetic resonance imaging for a left ventricular pseudoaneurysm found surreptitiously in 72-year-old man 2 weeks following an acute myocardial infarction. (Level of Difficulty: Beginner.).
Project description:A 56-year-old female, who immigrated to the USA from Honduras, presented with worsening shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and decreased exercise tolerance over the previous 2 months. She was diagnosed 1 year previously with non-ischemic dilated cardiomyopathy and non-sustained monomorphic ventricular tachycardia. An implantable cardioverter defibrillator was placed. Cause for her dilated cardiomyopathy was unknown at that time. On admission, her electrocardiogram showed low voltage complexes, with frequent premature ventricular contractions. Transthoracic two-dimensional echocardiogram (2D ECHO) showed severely reduced ejection fraction of 20%, severe mitral regurgitation with left ventricular (LV) hypokinesis, and inferolateral and inferior wall akinesis. On review of her records, a contrast 2D ECHO from the previous year revealed an aneurysm of the LV apical region. Live three-dimensional (3D) ECHO on her present admission showed persistent LV apical aneurysm. Computed tomography angiogram showed no atherosclerotic lesions. Multiple episodes of non-sustained ventricular tachycardia were recorded on telemetry. Based on these findings, the diagnosis of Chagas cardiomyopathy was entertained. Serological tests for Trypanosoma cruzi antibodies were done and returned positive. We report a case of chronic Chagas cardiomyopathy that was initially missed but ultimately diagnosed based on the finding of LV apical aneurysm. <Learning objective: Chagas cardiomyopathy is becoming increasingly prevalent in non-endemic countries. One hallmark finding associated with Chagas cardiomyopathy is left ventricle apical aneurysm. We were able to identify this finding with transthoracic contrast 2D ECHO and live 3D ECHO.>.
Project description:BackgroundLeft ventricular aneurysms (LVAs) are a well-appreciated complication of acute myocardial infarction. Ventricular aneurysms involving the left ventricle (LV) typically evolve as a result of anterior myocardial infarction and are associated with greater morbidity, complication rates, and hospital resource utilization. Incidence of LVA is decreasing with advent of modern reperfusion therapies; however, in the setting of excess morbidity, clinicians must maintain an appreciation for their appearance to allow timely diagnosis and individualized care.Case summaryThis case report describes the clinical history, investigation, appearance, and management of a patient with calcified apical LVA with history of previous anterior ST-elevation myocardial infarction. The patient was initially admitted for elective coronary angiography in the setting of worsening exertional dyspnoea and subsequently underwent coronary artery bypass graft, aneurysm resection, and LV reconstruction.DiscussionLeft ventricular aneurysms are an uncommon complication experienced in the modern era of acute myocardial infarction and current reperfusion therapies, but remain an important cause of excess morbidity and complication. Evidence-based guidelines for the diagnosis, workup, and subsequent management of LVAs are lacking. The imaging findings presented in this case serve as an important reminder of the appearance of LVAs so that timely diagnosis and individualized care considerations can be made.