Characteristics

• A true aneurysm is a circumscribed non-contractile outpouching of the left ventricle.

• Although there is a very rare congenital form, the majority occur as a complication of myocardial infarction. It rarely ruptures, but patients are at risk of arrhythmias and thromboembolic events that occur from clot formation within the aneurysm.

• A pseudoaneurysm, or false cardiac aneurysm, occurs acutely following trauma or a myocardial infarction, with a focal left ventricular rupture, localised haematoma and a high risk of delayed rupture and death.

Clinical features

• Most are asymptomatic and go without any problems.

• There is an association with arrhythmias, thromboembolic events and rarely cardiac failure.

Radiological features

• CXR – localised bulge in the left heart border. There is often a thin peripheral rim of calcification within the ventricular wall.

• Echocardiography – paradoxical movement of the left ventricular wall in systole is diagnostic. The aneurysm may contain thrombus.

Differential diagnosis

• Previous TB pericarditis, with a background of ischaemic heart disease, can have a very similar appearance on a frontal CXR. A lateral view may show absence of the localised posterior LV aneurysm. Echocardiography allows accurate characterisation of both pathologies.

Management

• No active treatment necessary.

• Occasionally anticoagulation for mural thrombus formation is needed.