A Case Report on Multimodal Imaging in Diagnosing True or False Ventricular Aneurysm

Background: True and false left ventricular (LV) aneurysms are two rare and severe complications of acute myocardial infarction (AMI). While differentiating between these entities is challenging, early treatment is crucial to guide surgery and prevent life-threatening complications.

Case Presentation: Here, two cases illustrating these two entities have been presented.

First Case: A 64-year-old patient, with high cardiovascular risk, was admitted for worsening dyspnea (NYHA class II). Physical examination revealed signs of left heart failure with pulmonary edema and mild mitral regurgitation. The electrocardiogram (ECG) showed lateral necrosis, and transthoracic echocardiography (TTE) revealed a true aneurysm of the LV lateral wall, mild mitral regurgitation, and severe LV dysfunction (left ventricular ejection fraction [LVEF] 25%). Cardiac magnetic resonance imaging (MRI) confirmed the diagnosis with transmural enhancement and severe LV dysfunction. Coronary angiography revealed triple-vessel disease. After stabilization with anti-ischemic and heart failure medications, the patient underwent triple coronary artery bypass grafting (CABG) with favorable outcomes.

Second Case: A 58-year-old male patient, with a medical history of diabetes and dyslipidemia, presented with brief chest pain at rest for the past two weeks. Physical examination was unremarkable, and an ECG showed an incomplete bundle branch block with negative Sgarbossa criteria. TTE revealed a false aneurysm in the LV lateral wall, confirmed by cardiac MRI, along with non-viability in the right coronary artery territory. Coronary angiography indicated triple-vessel disease that required surgical intervention; however, the patient remained asymptomatic after refusing surgery and was discharged on optimal medical therapy.

Conclusion: These two cases highlight the diagnostic challenge between true and false LV aneurysms. Multimodal imaging plays a critical role in ensuring accurate diagnosis and hence, guiding optimal management. Cardiac MRI with its advanced sequences can characterize these outpouchings very well, thus helping clinicians to better understand their natural history and to guide proper management decisions with accurate diagnosis.