A 70-year-old man is evaluated for worsening heart failure 6 weeks after a large anterior MI. Echocardiography reveals a thin-walled outpouching communicating with the left ventricular cavity via a narrow neck. Which feature on imaging most strongly supports the diagnosis of pseudoaneurysm over a true ventricular aneurysm?
- A Presence of mural thrombus
- B Outpouching confined to the apex
- C Neck width smaller than the maximum aneurysm diameter ✓
- D Diffuse ST-segment elevation on ECG
Correct answer: C. Neck width smaller than the maximum aneurysm diameter
Explanation
A true ventricular aneurysm has a wide neck, with the neck diameter being at least 50 percent of the maximum aneurysm diameter. A pseudoaneurysm, which is a contained rupture, has a narrow neck that is less than 50 percent of the sac diameter. Pseudoaneurysms lack true myocardial tissue and carry a high risk of rupture.
Reference: Braunwald's Heart Disease, 12th ed.
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Written and medically reviewed by the StethoPrep medical team.