Ruptured left ventricular pseudoaneurysm in the mediastinum following acute myocardial infarction: a case report

Left ventricular free wall rupture in myocardial infarction (MI) is often fatal, and only a few patients undergo operation. The cardiac rupture may be clinically undetected and lead to pseudoaneurysm. A left ventricular (LV) pseudoaneurysm is formed when cardiac rupture is contained by pericardium, organizing thrombus, and hematoma. It has been reported to occur mostly at the inferior segments of the left ventricle, following occlusion of the right coronary or left anterior descending branches [1]. Because of its rarity, the natural progression of pseudoaneurysm of the left ventricle is not well established. They are believed to have a poor prognosis because of a high probability of rupture. Here we report a case with LV pseudoaneurysm that occurred after a recent inferior MI and ruptured in the mediastinum.A 43-year-old man with history of prior myocardial infarction presented to our hospital with chest pain and shortness of breath; 8 months previously, the patient had been treated at the local hospital for ST segment elevation myocardial infarction with acute high lateral wall injury. He was treated with thrombolytic therapy. The patient was discharged without an echocardiogram and cardiac catherization due to limited resources, and he had not had a follow-up with a cardiologist because both doctors and the patient did not pay much attention to his condition as the symptoms had almost disappeared by then. Recently, our patient had been complaining of intermittent and slight chest pain, shortness of breath at rest, and frequent awakening due to chest distress at night for a duration of 2 weeks.Results of a physical examination indicated a blood pressure of 145/85 mm Hg, a heart rate of 88 beats/minute, a slightly expanded left margin of the heart, and a continuous 3/6 grade murmur between the third and fourth intercostal spaces at the left sternal border. An electrocardiogram examination revealed qR in leads I and aVL and inverted T-waves in leads I, II, aVL, and V