Aneurysm of the Left Ventricle

Left Ventricular Aneurysm

The Common Vein Copyright 2008

  • Definition
    •  well delineated, thin, scarred, or fibrotic wall
    • devoid of muscle or containing necrotic muscle,
    • Causes of Left Ventricular Aneurysm and Pseudoaneurysm
        • Post MI –
          • caused by total occlusion of the left anterior descending coronary artery and the absence of collateralization
          • RCA inferoposterior basal wall
          • Circumflex lateral wall
            • patients with multivessel disease,
              • aneurysms are uncommon  due to
              • extensive collateralization
        • hypertrophic cardiomyopathy and
        • Chagas disease,
    • Result
    • Functional
      • akinetic (without movement) or
      • dyskinetic
      • CHF
    • Structural
      • Size 1-8 cms
      • Shape
        • Round
      • Position
        •  apex and anterior wall are 70 to 85 %
        • inferoposterior basal wall RCA
        • lateral LVA secondary to left circumflex occlusion is exceedingly rare
      •  Character
Chronic Infarction at the apex of the LV with thinning and fibrosis of the myocardium
Study from 1960
Ashley Davidoff
THE COMMONVEIN.net
  • The wall of the aneurysm typically consists o
      • white fibrous scar and is very thin.
      • organized clot in over 50 percent of cases
  • Causes of Left Ventricular Aneurysm and Pseudoaneurysm
      • Post MI –
      • hypertrophic cardiomyopathy and
      • Chagas disease,
    • Complications
      • CHF
      • ventricular arrhythmias
      • arrhythmias
      • Rupture – rare
Normal LV vs apical aneurysm
Ashley Davidoff
THECOMMONVEIN.net
Duck-billed platypus, is a semiaquatic, egg-laying mammal endemic to eastern Australia,

Dr Lloyd Hawes

Never Discard Films
Courtesy Dr Lloyd Hawes
TheCommonVein.net
59 year old male who sustained an acute MI in November with a normal CXR and one month later went into CHF. Surgical removal of an aneurysmal sac
Courtesy Dr Lloyd Hawes
TheCommonVein.net

1 month later

59 year old male who sustained an acute MI in November with a normal CXR and one month later went into CHF. Surgical removal of an aneurysmal sac
Courtesy Dr Lloyd Hawes
TheCommonVein.net
59 year old male who sustained an acute MI in November with a normal CXR and one month later went into CHF. Surgical removal of an aneurysmal sac
Courtesy Dr Lloyd Hawes
TheCommonVein.net
70 year old male with cardiomegaly and a calcified apical aneurysm
Ashley Davidoff
TheCommonVein.net.
70 year old male with cardiomegaly and a calcified apical aneurysm
Ashley Davidoff
TheCommonVein.net.
70 year old male with cardiomegaly and a calcified apical aneurysm
Ashley Davidoff
TheCommonVein.net.

 

This cross sectional CT image of the heart shows calcified apex of the left ventricle associated with thrombus, characteristic of an LV aneurysm. The cause is almost certainly secondary to coronary artery disease and ischemic heart disease with secondary myocardial infarction. Courtesy Ashley Davidoff MD. 30472 code heart LV apex IHD CAD aneurysm calcification calcified MI cardiac imaging radiology CTscan
LV aneurysm with fat
The CommonVein.net
LV aneurysm with fat and dystrophic calcification
The CommonVein.net
LV aneurysm with fat and dystrophic calcification
The CommonVein.net
LV aneurysm with Calcium
The CommonVein.net
Focal LV aneurysm with Calcium
The CommonVein.net
Focal LV aneurysm with Calcium
The CommonVein.net
LV aneurysm with Thinning
The CommonVein.net
LV aneurysm with thrombus – acute or subacute
TheCommonVein.net
82 M LV aneurysm with thrombus – acute or subacute
TheCommonVein.net
LV aneurysm with thrombus – Chronic
TheCommonVein.net
LV aneurysm with thrombus – Chronic
TheCommonVein.net
LV aneurysm with posterior basal
RCA distribution
TheCommonVein.net

 

LV Aneurysm
Axial CT through the left ventricle (LV) shows rounding of the apex and thinning of the overlying myocardium. This finding is consistent with an apical LV aneurysm most likely caused by LAD disease.
Note the fat dysplasia in the apical myocardium which confirms the prior infarct.
Ashley Davidoff MD
0040 B heart 57 M aneurysm
70 year old male with apical aneurysm and associated subendocardial fat in the apex
Note also a dissection in the descending aorta
Ashley Davidoff
THECOMMONVEIN.net
56 year old male with an apical aneurysm with subendocardial fat and dystrophic calcification in the aneurysm. Note also the fat within the septum
Ashley Davidoff
THECOMMONVEIN.net

01213

Courtesy Ashley Davidoff MD 01213 esophagus + fx dilated + fx fluid filled + dx achalasia of the cardia +cardiac heart LV apex left ventricle calcified calcification aneurysm thrombus RS pleura pleural calcification asbestos related disease imaging radiology CTscan

30472

This cross sectional CT image of the heart shows calcified apex of the left ventricle associated with thrombus, characteristic of an LV aneurysm. The cause is almost certainly secondary to coronary artery disease and ischemic heart disease with secondary myocardial infarction. Courtesy Ashley Davidoff MD. 30472 code heart LV apex IHD CAD aneurysm calcification calcified MI cardiac imaging radiology CTscan

30473

This cross sectional CT image of the heart shows calcified apex of the left ventricle associated with thrombus, characteristic of an LV aneurysm. The cause is almost certainly secondary to coronary artery disease and ischemic heart disease with secondary myocardial infarction. Courtesy Ashley Davidoff MD. 30473 code heart LV apex IHD CAD aneurysm calcification calcified MI cardiac imaging radiology CTscan

32074

This cross sectional CT image of the heart shows the apex of the left ventricle associated with thrombus, characteristic of an LV aneurysm. The cause is almost certainly secondary to coronary artery disease and ischemic heart disease with secondary myocardial infarction. Courtesy of Ashley Davidoff M.D. 32074 code heart LV apex aneurysm thrombus aneurysm IHD CAD MI large cardiac imaging radiology CTscan

 

33511

This transverse CT scan through the apex of the left ventricle shows a focal calcification at the apex. The diagnosis evolves into a focal pseudoaneurysm of the LV apex. Courtesy Ashley Davidoff MD 33511 code heart LV apex calcified pseudoaneurysm inflammation immune rheumatic heart disease RHD cardiac imaging radiology CTscan

 

This transverse CT scan through the apex of the left ventricle shows a focal bulge at the apex. There is an associated small focal calcification in the myocardium that was noted on a CT 3 years prior in this patient with a diagnosis of a focal pseudoaneurysm of the LV apex. Courtesy Ashley Davidoff MD 33513 heart LV apex calcified pseudoaneurysm inflammation immune rheumatic heart disease RHD cardiac imaging radiology CTscan

33157

This power motion imaging echo of the heart showing a 4 chamber view, and demonstrating the left ventricle. The apex of the LV is rounded suggesting a LV aneurysm. Courtesy Philips Medical Systems 33157 code cardiac heart echo LV aneurysm dyskinetic segment apex imaging cardiac echo

 

42394.800

42394.800 heart cardiac LV left ventricle platypus shape fx dilated fx enlarged dyskinetic segment CTscan Davidoff MD

Pseudoaneurym at the base

References and Links

TCV