Korean J Radiol.  2014 Jun;15(3):330-333. 10.3348/kjr.2014.15.3.330.

Spontaneous Obliteration of Right Ventricular Pseudoaneurysm after Blunt Chest Trauma: Diagnosis and Follow-Up with Multidetector CT

• Kang T
• Kang MJ
• Kim JH

• KMID: 2078642
• DOI: http://doi.org/10.3348/kjr.2014.15.3.330

Abstract

Right ventricular (RV) pseudoaneurysm caused by trauma is very rare. We report a case of RV pseudoaneurysm which resolved without surgical treatment in a patient who survived a falling accident. Echocardiography failed to identify the pseudoaneurysm. Electrocardiography-gated CT showed a 17-mm-sized saccular pseusoaneurysm arsing from the RV outflow tract with a narrow neck. Follow-up CT after two months showed spontaneous obliteration of the lesion.

Keyword

Ventricular pseudoaneurysm; Blunt chest trauma; Computed tomography

MeSH Terms

Accidental Falls
Aneurysm, False/etiology/*radiography/ultrasonography
Cardiac-Gated Imaging Techniques/methods
Echocardiography/methods
Female
Follow-Up Studies
Heart Aneurysm/etiology/*radiography/ultrasonography
Heart Ventricles/injuries/radiography/ultrasonography
Humans
Middle Aged
Multidetector Computed Tomography/*methods
Remission, Spontaneous
Thoracic Injuries/*complications
Wounds, Nonpenetrating/*complications

Figure

• 

  Fig. 1 53-year-old female diagnosed with right ventricle pseudoaneurysm after 20-meter fall. A. Initial chest CT scan indicates contrast-enhanced pouch (arrow) adjacent to right ventricle outflow tract. B. Electrocardiography-gated cardiac CT scan, obtained on twentieth day of admission, shows pseudoaneurysm (17 × 7 mm) (asterisk) with long neck (arrow) arising from right ventricle. Note intact right coronary artery (arrowhead). C. Three-dimensional volume-rendered reconstruction shows intact right coronary artery (arrowheads) and right ventricular pseudoaneurysm (arrow). D. Final follow-up CT, obtained two months later, shows complete resolution of right ventricular pseudoaneurysm (arrow).

Reference

1. Prêtre R, Chilcott M. Blunt trauma to the heart and great vessels. N Engl J Med. 1997; 336:626–632.

2. RuDusky BM. Myocardial contusion culminating in a ruptured pseudoaneurysm of the left ventricle--a case report. Angiology. 2003; 54:359–362.

3. Grieco JG, Montoya A, Sullivan HJ, Bakhos M, Foy BK, Blakeman B, et al. Ventricular aneurysm due to blunt chest injury. Ann Thorac Surg. 1989; 47:322–329.

4. Maselli D, Micalizzi E, Pizio R, Audo A, De Gasperis C. Posttraumatic left ventricular pseudoaneurysm due to intramyocardial dissecting hematoma. Ann Thorac Surg. 1997; 64:830–831.

5. Frances C, Romero A, Grady D. Left ventricular pseudoaneurysm. J Am Coll Cardiol. 1998; 32:557–561.

6. Stewart S, Huddle R, Stuard I, Schreiner BF, DeWeese JA. False aneurysm and pseudo-false aneurysm of the left ventricle: etiology, pathology, diagnosis, and operative management. Ann Thorac Surg. 1981; 31:259–265.

7. Booth SA, Norton B, Mulvey DA. Central venous catheterization and fatal cardiac tamponade. Br J Anaesth. 2001; 87:298–302.

8. Ahmad RM, Umakanthan R, Lawson M, Leacche M, Solenkova NV, Byrne JG. Nonsurgical management of traumatic cardiac pseudoaneurysms. J Thorac Cardiovasc Surg. 2010; 139:e83–e85.

9. Shen X, Holmberg MJ, Sype J, Hunter C, Mooss AN, Mohiuddin SM. Real-time three-dimensional echocardiography in diagnosis of right ventricular pseudoaneurysm after pacemaker implantation. Echocardiography. 2006; 23:240–243.

10. Bozlar U, Yurtsever I, Ugurel MS, Ors F, Nural MS, Tasar M. Multidetector computed tomography in post-traumatic ventricular pseudoaneurysm. Clin Cardiol. 2009; 32:E72–E74.

11. Yeo TC, Malouf JF, Reeder GS, Oh JK. Clinical characteristics and outcome in postinfarction pseudoaneurysm. Am J Cardiol. 1999; 84:592–595.

12. Gueron M, Hirsch M, Venderman K, Freund H, Borman J. Pseudoaneurysm of left ventricle. Report of a case diagnosed by angiography and successfully repaired. Br Heart J. 1973; 35:663–666.

13. Smith RC, Goldberg H, Bailey CP. Pseudoaneurysm of the left ventricle: diagnosis by direct cardioangiography; report of two cases successfully repaired. Surgery. 1957; 42:496–510.

14. Yakierevitch V, Vidne B, Melamed R, Levy MJ. False aneurysm of the left ventricle. Surgical treatment. J Thorac Cardiovasc Surg. 1978; 76:556–558.