Post-infarct LV aneurysm vs pseudoaneurysm
Recommended: Cardiac MRI (LGE for scar transmurality + wall continuity) is the preferred imaging study for post-infarct lv aneurysm vs pseudoaneurysm. True aneurysm: gradual neck, all wall layers, dyskinesis.
Recommended study
Cardiac MRI (LGE for scar transmurality + wall continuity)
True aneurysm: gradual neck, all wall layers, dyskinesis. Pseudoaneurysm: narrow neck, contained rupture, high rupture risk.
If the default doesn't apply
Echo for screening
US
Transthoracic + Transesophageal echo
No contrast
Watch-outs
Pseudoaneurysm = surgical emergency
Even if asymptomatic, pseudoaneurysm has high rupture risk; surgical repair.
Pearls
- Aneurysm neck:body ratio < 0.5 suggests pseudoaneurysm.
- Mural thrombus common in true aneurysm — anticoagulation.
- LGE shows transmural scar in true aneurysm; pseudoaneurysm has discontinuous myocardium.