Non-Coronary Left Ventricular Pseudoaneurysm Diagnosed During the Evaluation of Pericarditic Chest Pain in a Young Woman in Benin: A Case Report

Left ventricular (LV) pseudoaneurysm is a contained rupture of the myocardial wall sealed off by the pericardium. It usually complicates myocardial infarction or cardiac surgery, whereas non-coronary forms are exceptional, particularly in young patients, and their etiology is often difficult to establish. We report the case of a 27-year-old woman with an unspecified childhood heart disease, admitted for prolonged pericarditic chest pain associated with fever, cough, weight loss and New York Heart Association (NYHA) class III dyspnea. Examination showed sinus tachycardia at 100 beats per minute, a body mass index of 18.97 kg/m 2 and isolated jugular venous distension. The electrocardiogram showed PR segment depression, and the chest radiograph showed cardiomegaly (cardiothoracic ratio 0.60) with a bulge of the left middle cardiac border. Transthoracic echocardiography, performed for the work-up of this chest pain, revealed a communicating LV pseudoaneurysm of the basal anterolateral wall (55 mm in diameter, 28 mm neck, no thrombus) and a moderate fibrinous pericardial effusion. Cardiac magnetic resonance imaging confirmed the diagnosis (sac of 62 × 49 mm) and showed no myocardial enhancement suggestive of myocarditis. Laboratory tests showed multifactorial anemia (hemoglobin 8.3 g/dL) with signs suggestive of hemolysis and a C-reactive protein level of 96 mg/L; blood cultures and the tuberculosis work-up were negative. The patient received high-dose aspirin and weight-adjusted colchicine, as first-line therapy for acute pericarditis, and a blood transfusion, with a favorable course after two weeks of hospitalization. Surgical repair was indicated, but cardiac surgery was not available in the country at that time. While awaiting a state-organized cardiac surgery mission, the patient was lost to follow-up, reportedly had four episodes of decompensated heart failure, and died of sudden circulatory collapse in October 2024, approximately nine months after diagnosis. No autopsy was performed; rupture of the pseudoaneurysm is suspected but remains a hypothesis. The etiology remains undetermined, and a congenital and/or infectious (pericardial) origin is possible but unproven. Echocardiography is the first-line examination, and because of the risk of rupture, surgical repair is recommended even in asymptomatic patients and should be made accessible in low-resource settings.