Presentación y evolución atípica de pseudoaneurisma encapsulado tras ruptura ventricular.
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| Title: | Presentación y evolución atípica de pseudoaneurisma encapsulado tras ruptura ventricular. |
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| Alternate Title: | Encapsulated pseudoaneurysm post-left ventricular rup ture: unusual presentation and follow-up. |
| Authors: | Bergier, Mariano G.1 (AUTHOR) mariano.bergier@hospitalitaliano.org.ar, del Castillo, Santiago1 (AUTHOR), Bagnati, Rodrigo1 (AUTHOR), Benger, Juan2 (AUTHOR), Tonso, Sebastián1 (AUTHOR), Pérez de Arenaza, Diego1 (AUTHOR), Falconi, Mariano1 (AUTHOR), Pizarro, Rodolfo1 (AUTHOR) |
| Source: | Medicina (Buenos Aires). ene/feb2025, Vol. 85 Issue 1, p225-228. 4p. |
| Subjects: | THERAPEUTICS, MYOCARDIAL infarction, LEFT ventricular dysfunction, COMPUTED tomography, PULMONARY function tests |
| Abstract (English): | External cardiac rupture with the development of a pseudoaneurysm is an uncommon complication of acute myocardial infarction (AMI) and do not always have typi cal presentations and can be challenging to diagnose. We present the case of a 59-year-old woman with no relevant cardiovascular history whose disease course was unusual. She initially presented with chest pain, dyspnea, and fever, and was diagnosed and treated for community-acquired pneumonia. Due to persistent symptoms, she went to the hospital where an electrocar diogram showed signs of an infarction. An echocardio gram revealed apical akinesia with a severely depressed ejection fraction and an associated thrombus. An AMI with differential diagnoses of an apical aneurysm versus a pseudoaneurysm was considered, and she was trans ferred to our center for further evaluation. The coronary angiography revealed an occlu sion in the mid-left anterior descending artery, with no other significant lesions. The magne tic resonance imaging and the computed tomography scans showed severe left ventricular dysfunction, subacute infarction, and an apical pseudoaneurysm with a fragmented thrombus. A surgical resolution was considered, but the computed tomography scans revealed severe emphysema, and the pulmonary function tests showed severe obstructive ventilatory impair ment. Any type of intervention was considered high risk, and it was decided to continue with medical treatment. Nine months later, the pa tient is still alive and asymptomatic. [ABSTRACT FROM AUTHOR] |
| Abstract (Spanish): | La rotura cardíaca externa con desarrollo de un pseu doaneurisma es una complicación infrecuente del in farto agudo de miocardio (IAM) y puede manifestarse de manera poco característica y constituir un desafío diagnóstico. Se presenta el caso de una mujer de 59 años sin an tecedentes cardiovasculares de relevancia, que consultó por dolor en el pecho, disnea y fiebre. Se diagnosticó una neumonía aguda de la comunidad y recibió tratamiento antibiótico. Debido a la persistencia de los síntomas vol vió a consultar y en un electrocardiograma se observa ron signos de infarto evolucionado. Un ecocardiograma reveló una fracción de eyección gravemente deprimida y acinesia apical con un trombo asociado. Se planteó el diagnóstico diferencial de un infarto con aneurisma apical versus un pseudoaneurisma por rotura cardíaca externa, por lo que fue referida a nuestro centro para una mayor evaluación. La angiografía coronaria reveló oclusión en la arteria descendente anterior, sin otras lesiones significativas. La resonancia magnética y la tomografía confirmaron la disfunción ventricular izquierda grave, con un infarto subagudo y un pseudoaneurisma apical con un trom bo fragmentado. Se consideró inviable una resolución quirúrgica dado que la tomografía reveló enfisema y las pruebas de función pulmonar mostraron deterioro ventilatorio obstructivo grave. De acuerdo con la pacien te, se decidió continuar con tratamiento médico. Nueve meses después, se mantiene asintomática. [ABSTRACT FROM AUTHOR] |
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| Database: | MedicLatina |
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| Abstract: | External cardiac rupture with the development of a pseudoaneurysm is an uncommon complication of acute myocardial infarction (AMI) and do not always have typi cal presentations and can be challenging to diagnose. We present the case of a 59-year-old woman with no relevant cardiovascular history whose disease course was unusual. She initially presented with chest pain, dyspnea, and fever, and was diagnosed and treated for community-acquired pneumonia. Due to persistent symptoms, she went to the hospital where an electrocar diogram showed signs of an infarction. An echocardio gram revealed apical akinesia with a severely depressed ejection fraction and an associated thrombus. An AMI with differential diagnoses of an apical aneurysm versus a pseudoaneurysm was considered, and she was trans ferred to our center for further evaluation. The coronary angiography revealed an occlu sion in the mid-left anterior descending artery, with no other significant lesions. The magne tic resonance imaging and the computed tomography scans showed severe left ventricular dysfunction, subacute infarction, and an apical pseudoaneurysm with a fragmented thrombus. A surgical resolution was considered, but the computed tomography scans revealed severe emphysema, and the pulmonary function tests showed severe obstructive ventilatory impair ment. Any type of intervention was considered high risk, and it was decided to continue with medical treatment. Nine months later, the pa tient is still alive and asymptomatic. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 00257680 |
