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A 63‐year‐old man with prior coronary artery bypass surgery presented to hospital complaining of acute left leg numbness, and the sensation that, “my heart is popping out of my chest”. Examination showed a cold, blanched left leg, and a pulsating mass in his left chest wall. Echocardiography disclosed moderate–severe left ventricular (LV) dysfunction with an apical pulsatile mass. After urgent femoral arterial embolectomy, he underwent cardiac magnetic resonance imaging, confirming the diagnosis of LV apical pseudoaneurysm (panel, arrow), with thrombus visible in the pseudoaneurysm wall (panel, arrowhead; video footage available at http://heart.bmj.com/supplemental). He underwent surgical patch repair of the pseudoaneurysm, with an unremarkable recovery.
LV pseudoaneurysms (“false aneurysms”) form when cardiac rupture is contained by adherent pericardium. Although most cardiac ruptures result in cardiac tamponade and death, the rupture may be contained by the visceral pericardium; hence the term, “contained myocardial rupture”. Clinical presentations include congestive heart failure and chest pain; systemic embolism, as occurred in this case, is uncommon. Fifty‐five per cent of pseudoaneurysms are caused by myocardial infarction, 33% by cardiac surgery, 7% by trauma, and 5% by infection. Diagnostic modalities include echocardiography, angiography, magnetic resonance imaging and computed tomography. Because the risk of rupture is 30–45%, anticoagulation is contraindicated and surgery is recommended.
To view video footage visit the Heart website—http://heart.bmj.com/supplemental
Copyright © 2007 BMJ Publishing Group and British Cardiovascular Society.