0:00

Our next case is a 74 year old woman with a history of

0:04

SC segment myocardial infarction one year ago.

0:08

And she had an abnormal mass like appearance on her echo

0:13

that they wanted to further evaluate with cardiac mr.

0:16

So just starting using our normal approach, two chamber,

0:22

not terribly abnormal.

0:24

There is maybe a little something here that looks

0:28

not quite normal, kind of thinned out there

0:31

or something that we'll have to explore further on.

0:35

Other views for chamber.

0:37

Again, nothing that's terribly remarkable on that view.

0:43

Three chamber, much the same, looks fairly normal.

0:49

This is a different view than what we've actually seen

0:54

on some of our other tests

0:55

and it's a little hard to orient your self.

0:59

This is an LVOT view.

1:01

And so really to kind of orient you,

1:05

this is the aortic outflow tract here

1:09

and this is probably right atrium right here

1:14

or is the right atrium.

1:15

This is the intraatrial septum slash membranous portion

1:19

of the intraventricular septum here.

1:22

The mitral valve is kind of somewhere over here.

1:25

And this is what I'm trying to show you right here.

1:27

This is kind of what they noticed on echo

1:30

and I think it'll become much more clear what

1:32

that actually is whenever we are going

1:35

through the short axis.

1:37

But if you look at this in this view, this kind of looks

1:41

like it's at least contracting with the heart or,

1:44

or sort of having some flow between, you know, this chamber

1:48

and, and what's going on in here.

1:50

So let's go to the short axis F here

1:52

and we're gonna start to work our way down.

1:56

Getting into the LV here, the basal lv.

1:59

And you can start to see here as I go down,

2:02

this is the mitral valve here.

2:04

This is the left ventricle right here.

2:06

And then we have this, what looks like now

2:09

a focal outpouching of that basal infra lateral segment.

2:13

And then we get to this slice

2:14

and it becomes very clear what that actually is.

2:18

So RV here, LV here,

2:22

this outpouching here.

2:24

Notice that we have, you know, kind of two little rems

2:28

to this that produce, uh, a neck like appearance here.

2:32

And then we have this structure which flow is coming in from

2:36

the left ventricle to, and we work our way down

2:39

and we can see that that is contracting opposite

2:43

to the heart contraction.

2:45

So it's kind of filling with blood during systole

2:47

and kind of having blood moved out during diastole.

2:52

This is an example, a very classic example

2:56

of an LV pseudo aneurysm

2:58

Related to primary myocardial infarction.

3:01

So I'll show you the LGE images here.

3:04

They provide a nice kind of overview of this as well.

3:08

So here we are on the short axis coming down from the base.

3:11

You can start to see the neck here of the pseudo aneurysm.

3:14

Notice that these walls were extremely thinned out

3:19

and that's usually in the setting

3:21

of a myocardial infarction.

3:22

That's what happens. You can get really significant wall

3:26

thinning and then those walls can actually rupture.

3:28

And what a pseudo aneurysm, of course is, is kind of one

3:31

of these contained ruptures that sort of walls itself off

3:34

and contains itself.

3:38

But there's sort of direct communication

3:40

from the LV into the pseudo aneurysm.

3:42

And notice in this particular case, we've got a lot

3:44

of mural thrombus associated with the pseudo aneurysm.

3:47

We'll take a look here on the three chamber

3:51

working our way down.

3:53

So here's the pseudo aneurysm here. Mural thrombus.

3:56

Let's go four chamber here. There it is again.

4:00

So very nice example.

4:02

Uh, another common complication associated with,

4:07

uh, myocardial infarction.

4:08

A left ventricular pseudo aneurysm.