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Left ventricular pseudoaneurysm or diverticulum: differential diagnosis and dynamic evaluation by catheter left ventriculography and ECG-gated multidetector CT

Departments of ¹ Diagnostic Imaging, ² Cardiology and ³ Cardiac Surgery, Rambam Health Care Campus, B Rappaport School of Medicine, ⁴ Technion-Israel Institute of Technology, Haifa, Israel, ⁵ Leonard M Miller School of Medicine, University of Miami, Miami, FL, USA

View larger version (60K): [in this window] [in a new window]   Figure 1. (a) Right anterior oblique (RAO) view of contrast left ventriculography at peak diastole demonstrates a small diastolic out-pouching of contrast material at the left ventricular inferior/medial wall (dotted arrow). (b) RAO view of contrast left ventriculography at peak systole demonstrates almost complete collapse of the previously denoted small diastolic out-pouching of contrast material at the left ventricular inferior/medial wall (dotted arrow).

View larger version (58K): [in this window] [in a new window]   Figure 2. (a) Slab maximal intensity projection (MIP) reformat of ECG-gated MDCT in RAO view at peak diastole demonstrates tiny myocardial focal disruption and a small diastolic out pouching of contrast material at the left ventricular inferior/medial wall (dotted arrow). Findings are consistent with a left ventricular pseudoaneurysm neck and lumen. (b) Slab MIP reformat of ECG gated MDCT in RAO view at peak systole demonstrates temporary occlusion of the neck of the small left ventricular pseudoaneurysm and almost complete collapse of the pseudoaneurysm lumen at the left ventricular inferior/medial wall (dotted arrow).