Six weeks after a large anterior MI, a 60-year-old man presents with recurrent embolic stroke. Echocardiography shows a thin-walled outpouching at the cardiac apex communicating with the left ventricular cavity through a narrow neck, with Doppler flow across the narrow channel. Which statement about this lesion is correct?

• A It contains all three layers of the ventricular wall and carries a low rupture risk
• B It results from contained free wall rupture and warrants surgical repair ✓
• C It is best managed with lifelong anticoagulation alone
• D It represents a false aneurysm of the pericardium unrelated to the prior infarct

Explanation

A narrow-necked apical outpouching six weeks after infarction is a pseudoaneurysm, formed when a contained free wall rupture is sealed by adherent pericardium and thrombus; its wall lacks myocardium. Unlike a true aneurysm, which has a wide neck and low rupture risk, a pseudoaneurysm frequently enlarges and ruptures, so surgical repair is indicated. Anticoagulation treats associated thrombus but does not address the rupture risk.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.