Giant left ventricular outflow tract pseudoaneurysm presenting as anterior mediastinal mass: diagnosis by MDCT
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Giant left ventricular outflow tract pseudoaneurysm presenting as anterior mediastinal mass: diagnosis by MDCT Senthil Kumar Aiyappan 1
&
Vinisha Kamadana 1 & Patel Ruchik Anilbhai 1 & Kshitija Narayan Vinchurkar 1
Received: 24 June 2020 / Revised: 12 July 2020 / Accepted: 14 July 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract We report a case of giant left ventricular outflow tract pseudoaneurysm diagnosed by multidetector computed tomography cardiac angiography. This report highlights the importance of preoperative computed tomography in the evaluation of left ventricular outflow tract pseudoaneurysm which can be kept as a differential diagnosis for anterior mediastinal masses. Keywords CT . Pseudoaneurysm . Idiopathic . Ultrasound
Case report A 44-year-old male patient presented with grade 2 shortness of breath and a dull aching persistent pain in chest for 3 days. Pain was not aggravated by exertion. Patient did not have a history of diabetes, hypertension, pre-existing cardiac disease, or trauma. Chest radiograph demonstrated a large homogenous mass lesion in the anterior mediastinum abutting left heart border (Fig. 1). Routine blood tests and electrocardiogram (ECG) were entirely normal. Echocardiogram showed the presence of a large aneurysm, probably arising from left ventricular outflow tract (LVOT) or left sinus of Valsalva. No other significant finding was noted on echocardiogram. Multidetector computed tomography (MDCT) cardiac angiography showed presence of a large pseudoaneurysm, measuring 7.6 × 7.5 × 7.4 cm, with a wide neck measuring 2.7 cm. It was arising from the LVOT, involving its left lateral wall, and extending to anterior mediastinum compressing the main pulmonary artery, left pulmonary artery, left atrium, and the adjacent upper lobe and lingula of left lung (Figs. 2 and 3). The lung was normal, except for compression subsegmental atelectasis of the left upper lobe.
There was no thrombosis noted within the aneurysmal sac. No evidence of rupture was noted. The aortic root and the coronary arteries were normal (Figs. 2 and 3). Mild right pleural effusion was noted. The pulmonary arteries were normal. Catheter coronary angiography was not done. Patient underwent surgical repair of the pseudoaneurysm. On surgical exposure, aneurysm neck was found to be arising from the left lateral aspect of LVOT, below the left coronary sinus. Opening of the sac was closed with interrupted pledgeted sutures. Postoperative period was uneventful. The cause for pseudoaneurysm was not known and likely idiopathic.
* Senthil Kumar Aiyappan [email protected] 1
Department of Radiodiagnosis, SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu District, Tamil Nadu 603203, India
Fig. 1 Chest X-ray showing homogenous opacity abutting left cardiac border
Indian J Thorac Cardiovasc Surg
Fig. 2 a Coronal CT angiography image showing large pseudoaneurysm (white arrow) arising from the left ventricular outflow tract just below the aortic root on
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