Six months after a large anterior myocardial infarction, a 58-year-old man has a persistent apical bulge on echocardiography. Imaging shows the bulge communicates broadly with the ventricular cavity, and its wall contains myocardium continuous with the rest of the ventricle. Which feature best separates this lesion from a false (pseudo) aneurysm?

• A Its wall is composed of organized thrombus and pericardium
• B Its outer wall contains surviving myocardium stretched into the bulge ✓
• C It arises from complete tearing of all three layers of the ventricular wall
• D It carries a high risk of spontaneous rupture

Explanation

A true ventricular aneurysm is a late complication of a healed transmural infarct in which thinned scarred myocardium stretches outward; because fibrous scar is strong, it rarely ruptures. A pseudoaneurysm results from frank free-wall rupture contained by adherent pericardium and hematoma, so its wall lacks myocardium and it can rupture at any time. Option A describes the pseudoaneurysm wall, option C describes the mechanism producing a pseudoaneurysm, and option D is the danger of the pseudoaneurysm, making B the only true-aneurysm feature.

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

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Written and medically reviewed by the StethoPrep medical team.