0:00

Okay, this next case is interesting

0:02

and it's a little bit unique in that it's not a classic

0:07

coronary disease cause, but I think an important example

0:10

nonetheless, um, this patient, um, is elderly

0:15

and underwent a transcatheter aortic

0:17

valve replacement procedure.

0:19

And part of that involves doing invasive angiogram.

0:23

Um, but we can obviate that by looking at the CT

0:26

in this image though, we did a follow-up CT

0:28

after the transcatheter aortic valve replacement.

0:31

There was not much in the way of coronary disease,

0:33

but in placing the device, you have

0:35

to put a stiff wire into the left ventricle

0:37

and you can see there's the balloon

0:39

expandable TAVR in place.

0:41

But what I wanted to most show you

0:44

was when you look at the ventricle,

0:47

and I'm just reforming it into cardiac planes here,

0:50

you can see that there's a subtle abnormality.

0:53

Um, and this is not the most perfectly gated scan,

0:56

but we always get a couple of different phases.

0:58

And you see here, there is hypo enhancement

1:02

and some thinning as well as outpouching of contrast,

1:06

which has a very odd appearance.

1:10

And if I look in this long axis view,

1:13

I see the classic narrow neck

1:15

and wide body of a pseudo aneurysm.

1:17

So this is another complicated procedure resulting in a

1:21

pseudo aneurysm of the left ventricle.

1:23

Um, so even without looking at any ECG gated phases,

1:26

you can see the abnormality here

1:27

and note that this is, again, a surgical emergency

1:30

because it's a pseudo aneurysm rather than a true aneurysm.

1:33

Uh, other things that favor a pseudo aneurysm

1:35

are inferior locations.

1:37

So I've shown you two, um, rather than apical location,

1:40

which tends to be, uh, true aneurysm.

1:42

So true aneurysms not a surgical emergency.

1:45

Uh, pseudo aneurysms, uh, are a surgical emergency

1:48

and it can be very difficult to distinguish these.

1:50

So if you're not sure, it's better to say that than

1:53

to mischaracterize it as a more benign entity.

1:57

And as you know, not all cases read the rule book.

1:59

So you wanna just match those characteristics

2:02

with the location and the process by which it happened

2:05

to make sure you don't have a misclassification,

2:08

which could be disastrous for the patient.