History is 67 year-old man with aneurysm of the left ventricle from prior myocardial infarction. MRI evaluation requested to evaluate for associated thrombus.
MRI examination of the heart was performed. Black blood imaging was performed through the heart using DIRFSE sequence followed by bright blood cine gradient echo imaging using an SSFP pulse sequence in the long axis and short axis planes. Gadolinium based contrast was administered intravenously and postcontrast imaging was performed through the left ventricle in the short axis and two chamber planes. Comparison is made with CT scan of the heart performed on 9/5/2012.
Overall the heart is normal in size with mild enlargement of the left ventricle. As seen on prior CT scan there is a true aneurysm of the inferior wall of the left ventricle at the base. The aneurysm measures about 3 cm in diameter and is best seen on the 2 chamber view. The mouth of the aneurysm measures 2.7 cm in diameter. There is dyskinetic wall motion at the location of the true aneurysm. No other wall motion abnormalities are seen. After intravenous administration of contrast no filling defects are seen to suggest thrombus formation. There is subendocardial delayed enhancement of the inferior wall at the base of the left ventricle extending into the inferoseptal region of the interventricular septum at the base. This corresponds to the location of the true aneurysm. The delayed enhancement involes about 50% of the myocardial thickness in this region. Just apical to the true aneurysm in the midportion of the left ventrcile delayed enhancement involves the full thickness of the myocardium at the inferior wall. The appearance is consistent with prior myocardial infarction of the distal RCA territory. There is no delayed enhancement in the apical regions of the left ventrilce.
Impression: True aneurysm involving the inferior wall of the left ventricle. No evidence of associated thrombus. There is associated myocardial delayed enhancement consistent with prior infarction in the territory of the distal right coronary artery. This also involves the inferoseptal segment at the base.
MRI examination of the heart was performed. Black blood imaging was performed through the heart using DIRFSE sequence followed by bright blood cine gradient echo imaging using an SSFP pulse sequence in the long axis and short axis planes. Gadolinium based contrast was administered intravenously and postcontrast imaging was performed through the left ventricle in the short axis and two chamber planes. Comparison is made with CT scan of the heart performed on 9/5/2012.
Overall the heart is normal in size with mild enlargement of the left ventricle. As seen on prior CT scan there is a true aneurysm of the inferior wall of the left ventricle at the base. The aneurysm measures about 3 cm in diameter and is best seen on the 2 chamber view. The mouth of the aneurysm measures 2.7 cm in diameter. There is dyskinetic wall motion at the location of the true aneurysm. No other wall motion abnormalities are seen. After intravenous administration of contrast no filling defects are seen to suggest thrombus formation. There is subendocardial delayed enhancement of the inferior wall at the base of the left ventricle extending into the inferoseptal region of the interventricular septum at the base. This corresponds to the location of the true aneurysm. The delayed enhancement involes about 50% of the myocardial thickness in this region. Just apical to the true aneurysm in the midportion of the left ventrcile delayed enhancement involves the full thickness of the myocardium at the inferior wall. The appearance is consistent with prior myocardial infarction of the distal RCA territory. There is no delayed enhancement in the apical regions of the left ventrilce.
Impression: True aneurysm involving the inferior wall of the left ventricle. No evidence of associated thrombus. There is associated myocardial delayed enhancement consistent with prior infarction in the territory of the distal right coronary artery. This also involves the inferoseptal segment at the base.