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2010-09-07-16 Answer to the case of the week #283 © Perez-Canto
Answer to the case of the week #283

December 16, 2010 - January 6, 2011.

G. Perez-Canto Ch, MD., Alberto Sosa Olavarria, MD., H. Parra Venero, MD.

CEUSP. Valencia. Venezuela.

Case report

This is a case of a 29-year-old patient, G1 P0 without previous medical history. She was referred to our center at 20 weeks of gestation for a fetal hydrops and chest tumor of cystic appearance.  Amniocentesis was performed with a normal result - karyotype, 46 XX.

Our differential diagnosis included bronchogenic cyst, pericardial cyst, mediastinal cystic teratoma and ventricular aneurysm. Doppler imaging showed a flow within the cystic lesion and it's filling from the left ventricle. This excluded all of our differential diagnosis except of ventricular aneurysm. Left ventricle was markedly dilated with large, bulging aneurysm which was occupying large portion of the left hemithorax. Heart was shifted to the right.

Patient opted for pregnancy termination based on the ultrasound findings. The final diagnosis according to the pathologist was left ventricular aneurysm caused by myocardial infarction.

Images 1- 4: 4-chamber view of the heart, note large aneurysm of the left ventricle (*). Ventricular septum is pushed towards the right ventricle.

Image 5,6: Image 5 shows a parasagittal view of the thorax and abdomen with some ascites and thoracic effusion. Image 6 shows a Doppler imaging of the heart, there is a turbulent flow in the right heart.

Image 7: 3D-image of the chest, note that heart is shifted to the right and aneurysm filling the left hemithorax (*).

Video 1,2: 4-chamber view and large ventricular aneurysm.

Video 3: 3D view of the heart a ventricular aneurysm.

Images 8,9: Image 8 shows a fetus. Image 9 shows the autopsy of the fetal chest, note bulging heart aneurysm.

Images 10,11: Image 10 shows a ventricular aneurysm is filled with thrombus. Image 11 shows a section of the heart, aneurysm (*) is originating from the left ventricle.

Javier Cortejoso send us again very nice and detailed answer.

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