Incidental RVOT aneurysms can be detected by MDCT during acute pericarditis evaluation and may be safely managed conservatively if asymptomatic and non-obstructive.
Right ventricular outflow tract (RVOT) aneurysms are rare, often linked to congenital defects or surgery, and their incidental detection during acute pericarditis is unreported. This case highlights the diagnostic role of imaging in atypical presentations. A 32-year-old male presented with a 2-week history of sharp, pleuritic chest pain worsened by inspiration and coughing, partially relieved by nonsteroidal anti-inflammatory drugs (NSAIDs). He had a 10 pack-year smoking history but no prior cardiac disease. Physical examination was unremarkable. Laboratory tests showed mildly elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Electrocardiography (ECG) was normal, but transthoracic echocardiography revealed a left ventricular ejection fraction (LVEF) of 40%, right ventricular enlargement, and moderate pericardial effusion. Multidetector computed tomography (MDCT) with pulmonary thromboembolism (PTE) protocol excluded PTE but incidentally identified RVOT aneurysm. Conservative management with aspirin and colchicine led to symptom resolution; at 6-month follow-up, the patient was asymptomatic with stable imaging. This incidental finding underscores MDCT's utility in detecting coexisting structural anomalies in patients presenting with pericarditis. Conservative management is appropriate for asymptomatic cases without obstruction.
Tabibian et al. (Fri,) studied this question.