Characterizing a Left Ventricular Pseudoaneurysm With Photon-Counting Detector CT

Background: Ventricular pseudoaneurysms are a rare but potentially fatal complication of myocardial infarction. Accurate differentiation from true aneurysms is crucial given the risk of rupture. Case Summary: A 57-year-old woman presented with acute chest pain and progressive dyspnea. Electrocardiography showed signs of chronic infarction, while echocardiography revealed an aneurysmal structure and pericardial effusion. Photon-counting detector computed tomography (PCD-CT) was able to identify a large inferoseptal pseudoaneurysm with mural thrombus, occlusion of the right coronary artery, myocardial fibrosis consistent with infarction, and pericardial thickening suggesting concomitant pericarditis. Cardiac magnetic resonance imaging confirmed the PCD-CT findings and showed no signs of edema, indicating that the infarction was chronic. The patient subsequently underwent successful surgical aneurysmectomy. Discussion: This case highlights the diagnostic capabilities of PCD-CT in cardiac imaging, including late iodine enhancement and extracellular volume measurements to detect myocardial fibrosis. Take-Home Message: PCD-CT allows evaluation of cardiac anatomy, coronary arteries, cardiac function, and myocardial tissue as a one-stop shop, even in a complex surgical case.