JACC Case Rep. 2025 Dec 17;30(41):106207. doi: 10.1016/j.jaccas.2025.106207.
ABSTRACT
The differential diagnosis of aneurysmal dilation of the ventricular wall includes aneurysm, pseudoaneurysm, and diverticulum. Aneurysm and pseudoaneurysm are associated with myocardial ischemia, whereas diverticulum is a congenital anomaly. These conditions can be differentiated using transthoracic echocardiography, and accurate differentiation is crucial because pseudoaneurysms carry a high risk of rupture and require urgent surgical intervention. We describe 3 cases of left ventricular outpouchings with distinct etiologies and clinical implications. The first case involved a true inferior wall aneurysm with thrombus in a patient presenting with heart failure, which was successfully managed with surgical resection. The second case featured multiple pseudoaneurysms and a ventricular septal defect after anterior myocardial infarction complicated by cardiogenic shock, requiring veno-arterial extracorporeal membrane oxygenation, revascularization, and surgical repair. The third case was an incidental finding of a large inferolateral diverticulum in a minimally symptomatic patient. These cases illustrate the diverse presentations of left ventricular outpouchings and underscore the importance of accurate diagnosis and tailored management strategies.
PMID:41945539 | DOI:10.1016/j.jaccas.2025.106207