Pulsatile thoracal mass: a rare case of large left ventricular pseudoaneurysm

Left ventricular pseudoaneurysms (LVPA) develop after myocardial infarction, trauma, infection and either valvular or ventricular surgery. We present here an unusual case of LVPA appearing like a pulsatile mass, which was easily seen from the chest wall. A 55-year-old woman was admitted to our clinic with a pulsatile mass and trill, easily seen on the anterior chest wall 6 weeks after coronary artery bypass graft (CABG) surgery and endoaneurysmorrhaphy operation. Contrast-enhanced tomography showed a soft tissue mass detected close to the subcutaneous fat tissue of the anterior chest wall located in the left hemithorax. Left ventriculography was consistent with a large pseudoaneurysm in the apical wall of the left ventricle. Cardiopulmonary bypass was established with femoral cannulation, and endoaneurysmorrhaphy and CABG x 1 operations were carried out. The patient was discharged home on postoperative day 15. Follow-up echocardiography showed successful repair and shrinkage of the aneurysm, and the patient remained asymptomatic without any clinical event during our follow-up. LVPA usually present with heart failure. However, some patients may have recurrent tachyarrhythmia, progressive dyspnea, nonspecific chest pain, or thromboembolism, or remain clinically silent. When a patient is seen after cardiac surgery with a pulsatile mass detected on the chest wall, LVPA should be considered in the differential diagnosis.

Pulsatil torakal kitle: Nadir görülen bir sol ventrikül psödoanevrizmasý

ve ventriküler cerrahi sonrasý geliþirler. Bu yazýda, toraks ön duvarýnda pulsasyonu kolayca görülebilen bir sol ventrikül psödoanevrizmasý sunuldu. Elli beþ yaþýndaki kadýn hasta, koroner arter baypas (CABG) ve sol ventrikül gerçek anevrizma onarým ameliyatý sonrasý altýncý haftada kliniðe sol toraks ön duvarýnda kolaylýkla görülen ve trill alýnan pulsatil kitle ile baþvurdu. Kontrastlý toraks tomografisinde, sol toraks ön duvarýnda interkostal mesafeyi aþýp cilt altý yað dokusuna yakýnlýk gösteren yumuþak doku kitlesi görüldü. Sol ventrikülografide geniþ bir sol venrikül apikal psödoanevrizmasý saptandý. Femoral kanülasyon ile kardiyopulmoner baypasa girilen hastada, endo-anevrizmorafi ve CABG x 1 ameliyatý gerçekleþtirildi. Hasta 15. gün þifa ile taburcu edildi. Kontrol ekokardiyografisinde baþarýlý anevrizma tamiri rapor edilen hasta, ameliyat sonrasý beþinci ayda olup takibi devam etmektedir. Sol ventrikül psödoanevrizmasý sýklýkla kalp yetersizliði ile kendini gösterir, ancak bazý hastalar nükseden taþiaritmi, tromboembolizm, progresiv dispne, non-spesifik göðüs aðrýsý ya da hafif þikayetlerle baþvurabilirler. Kalp cerrahisi geçirmiþ ve göðüs ön duvarýnda pulsatil kitle þikayetiyle baþvuran bir hastada mutlaka sol ventrikül psödoanevrizmasý ayýrýcý tanýda düþünülmelidir.