Key result
TTE and SPECT complementarily detect LV pseudoaneurysms but demand high clinical suspicion for insidious presentations.
Why the study?
Left ventricular pseudoaneurysm is a surgical emergency, but diagnosis is often delayed due to its insidious presentation.
Can TTE and SPECT with CT attenuation correction detect left ventricular pseudoaneurysm?
Can TTE and SPECT with CT attenuation correction detect left ventricular pseudoaneurysm?
TTE and SPECT with CT attenuation correction can serve a complementary role in detecting left ventricular pseudoaneurysms, though cardiac imagers must be cognizant of at-risk patients due to the low sensitivity of these tests.
Background Left ventricular pseudoaneurysm (LVP) is considered a surgical emergency; however, diagnosis is often delayed owing to its often-insidious presentation. Case summary We present a case of a patient with nonspecific symptoms who was found to have a massive LVP. Retrospective review of a transthoracic echocardiogram (TTE) and single photon emission computed tomography (SPECT) with computed tomography (CT) attenuation correction two years before this presentation demonstrates a similarly sized LVP that was initially undetected, as it mimicked normal anatomy. Discussion Common, readily available testing after myocardial infarction, such as TTE and SPECT with CT attenuation correction, are not traditionally utilized for LVP diagnosis because of their low sensitivity. This case demonstrates that these tests may serve a complementary role, providing an opportunity to quickly detect abnormalities and expedite definitive testing. However, cognizance of at-risk patients by cardiac imagers is paramount to increase detection.
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Deets et al. (2026) studied this question. Transthoracic echocardiography and SPECT can complementarily detect left ventricular pseudoaneurysms, but require high clinical suspicion by cardiac imagers to avoid missing insidious presentations.
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