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Ventricular Aneurysm (Case 2)

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0:00

So this next case, it won't be a surprise

0:02

that we have extensive coronary atherosclerosis.

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Um, but let's jump right to the findings.

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I can see the LED is probably heavily

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diseased, if not occluded.

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Uh, and I just wanted to show you this left ventricle,

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which I think there'd be no, uh,

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in fact lemme just change, uh, views here.

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Uh, no question in anyone's mind.

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There's a lot of thinning of the interseptal wall,

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some calcification and some fatty metaplasia.

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Let's do a little thickening just to de-noise it,

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and then we'll talk about the sequela of mi.

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So, um, the tissue characterization

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of ventricle is important and, uh, what we're seeing here,

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and I'll just strip away the chest wall just to show

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that remodeling.

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Um, but there's a distinct change in the thickness,

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and this is the anterior and septal wall, so LAD, um,

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and you can see it on multiple views, um,

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but a lot of hypo enhancement, some very dark myocardium,

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consistent with fatty metaplasia calcification

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in the sub endocardium.

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And then we're gonna really, uh, make sure we don't miss

1:02

that there, I think a little layman

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or thrombus there in the left ventricle.

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Uh, important to note thrombus can calcify that tends not

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to go away, but portions of this are noncalcified.

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And this does fit the expected territory of an LED.

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So, um, basically all the hallmarks of a aneurysmal,

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old infarct in the ventricle.

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We can also look at all the cardiac cycle phases here.

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I'm just popping in some ECG gated images,

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which you can see there was some difficulty,

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not unexpectedly, some dysrhythmia.

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Uh, and when you look here, you can see basically a kinesis

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and maybe even a little dyskinesis, dyskinesis being one

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of the hallmarks of aneurysm.

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So aneurysm thrombus formation at the site of a

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territorial remote myocardial infarction.

Report

Faculty

Brian Ghoshhajra, MD, MBA, MSCCT

Academic Chief, Cardiovascular Imaging and Associate Chair, Operations Analytics

Massachusetts General Hospital / Harvard Medical School

Tags

Vascular

Myocardium

Coronary arteries

Cardiac Chambers

Cardiac CT (SCCT Cat B1 Video Case)

Cardiac

CTA

CT

Angiography