Gated radionuclide angiography for the differential diagnosis of true left ventricular aneurysm and pseudoaneurysm: A case report

Our purpose was to evaluate ventricular function by the use of gated radionuclide angiography, in a patient admitted for a suspected left ventricular pseudoaneurysm. Our subject was a male patient aged 62 years old, who, in January of 1989, had an inferoposterior AMI; after discharge his clinical condition worsened progressively, with dyspnea, and weight loss. We assessed ventricular function and morphology using routine cardiovascular noninvasive techniques as well as Doppler echocardiography, contrast ventriculography, and gated radionuclide angiography. Contrast ventriculography, Doppler echocardiography, and gated radionuclide angiography indicated the presence of a left ventricular pseudoaneurysm connected through a small orifice with the ventricular cavity. Gated radionuclide angiography, in particular, showed an image of the ventricular cavity with a zone of paradoxical kinesis. The aneurysmal cavity was emptied during diastole, with an opposite procedure of the ventricular cavity during the cardiac cycle. Because of deteriorating heart failure, the patient underwent short-term surgery, and the diagnostic suspicion was belied by the postoperative report. The new cavity, discovered in the posteroinferior myocardial segment, was highly suggestive of a pseudoaneurism, but the postoperative report belied our diagnosis. These observations suggest the usefulness, and the limitations, of the use of all the parameters that can be obtained from gated radionuclide ventriculography.