Wk 5, Case 4 - Review

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Report

Patient History
72 year old man with chest pain. 2 Cardiac MR examinations 3 months apart are presented.

Images 1A-C at initial presentation and 2A-D, 3 months post initial MRI.

Findings
On initial presentation (1A-C) there is infarction seen by full thickness enhancement involving the subendocardium in the inferior wall of the left ventricle in the basal and mid ventricular segments. Low signal intensity areas within the hyperenhanced tissue represent areas of contrast non penetration due to no reflow and are an adverse prognostic feature. The inferior wall of the left ventricle on cine images is dyskinetic and aneurysmal though appears continuous.

At the 3 months post MR study (2A-D) there is a large outpouching arising from the inferior wall of the left ventricle at the site of infarction. The inferior wall of the left ventricle is discontinuous rather abruptly and the outpouching is contained by enhancing pericardium and a low signal intensity thrombus. The left ventricular ejection fraction is severely reduced ( less than 35%).

Impressions
Left ventricular inferior wall rupture post MI and pseudoaneurysm formation

Case Discussion

Faculty

Anil Attili, MD

Clinical Associate Professor

Michigan Medicine

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Wk 5, Case 4 - Review