BETWEEN A CLOT AND A RUPTURE: A CHALLENGING DECISION

TOPIC: Imaging TYPE: Medical Student/Resident Case Reports INTRODUCTION: Cardiac pseudoaneurysms is an uncommon sequelae of transmural myocardial infarctions. They have the potential to compromise ventricular stroke volume and are a frequent source thrombus formation due stasis swirling blood in area. We present challenging case pseudoaneurysm with that anticoagulation was not pursued risk wall rupture. CASE PRESENTATION: A 57-year-old male medical history coronary artery disease status post percutaneous intervention left circumflex presented for shortness breath. On arrival, patient tachycardic, normotensive saturating above 95% on room air. Chest x-ray performed which showed interstitial edema. Given concern decompensated heart failure, transthoracic echocardiogram performed. This revealed ejection fraction 25% dilatation, concerning aneurysm hypoechoic area demonstrating possible thrombus. With unclear diagnosis, cardiac magnetic resonance imaging(MRI) pursued, large inferolateral mural Upon appreciation thrombus, highly considered. However, deemed provide critical structural support atrophic segment pursued. Patient received IV diuretics discharged stable condition. At six months follow up, overall good clinical condition repeat TTE no significant changes. DISCUSSION: Most cases as sequela form contained rupture ventricle by either pericardium or organized Pseudoaneurysms known poor prognosis given high If untreated, 30-45% first year. Due rarity pseudoaneurysms, there randomized controlled trials determine treatment choices. medically managed adequate pressure control those complicated thrombi. thrombi also endothelialize within myocardium, decreasing its embolic potential. Theoretically, can stability between myocardium volatile pseudoaneurysm. Disrupting this process may place more lead rupture, possesses significantly mortality rate. CONCLUSIONS: Avoiding should be considered incidences pseudoaneurysms. As evidenced case, type scenario warrants further investigation into outcomes who receive versus do not. REFERENCE #1: Bisoyi S, Dash AK, Nayak D, Sahoo Mohapatra R. Left diagnosis dilemma. Ann Card Anaesth. 2016;19(1):169-172. doi:10.4103/0971-9784.173042 #2: Mathur M, Gupta S. Pseudoaneurysm- Death Defying Entity. J Clin Diagn Res. 2016;10(6):TD06-TD7. doi:10.7860/JCDR/2016/19956.7936 #3: Gatewood RP Jr, Nanda NC. Differentiation from true two dimensional echocardiography. Am Cardiol. 1980 Nov;46(5):869-78. doi: 10.1016/0002-9149(80)90442-7. PMID: 7435399. DISCLOSURES: No relevant relationships Pooja Dhruva, source=Web Response Fadi Kandah, Naji Maaliki, Edin Sadic, disclosure file Raj Shukla