The Forgotten Blow.

Received: 24.08.2016; Accepted: 02.02.2017 Fig. 1: (A) ECG showing non-specific ST-T changes; (B) Broad medial margin in chest X-ray. (C) Modified 2-chamber view in echo showing the neck of pseudoaneurysm with bidirectional flow across the narrow neck in colour Doppler study (D). CT scan in transverse and coronal plane shows the pseudoaneurysm with calcified margins (E,F). Subtracted black blood and white blood axial MRI images of mediastinum showed a pseudoaneurysm with turbulence in transverse and coronal planes (G,H) mm X 102 mm X 70 mm] thin walled well defined lesion with calcif ied margins seen close to the left lateral wall of left ventricle with vascular type of enhancement [E, F]. Subtracted black blood and white blood axial MRI images of mediastinum showed a pseudoaneurysm with turbulence [G, H]. Left ventricular pseudoaneurysm form subsequent to cardiac rupture and is contained by the overlying pericardium and scar tissue.1,2 True aneurysms are dyskinetic areas of thinned full thickness myocardium.2 The ratio of the maximum internal diameter of the orifice to the maximum internal diameter of the cavity is usually less than 0.5 in the cases of a pseudoaneurysm, and between 0.9 and 1.0 in the cases of a true aneurysm.4 Most cases are a sequel of myocardial infarction, prior cardiac surgery and bacterial endocarditis but may rarely occur subsequent to trauma. Congestive heart failure, dyspnea and chest pain are the most frequently reported symptoms.3 Though a few cases of delayed presentation of LV pseudoaneurysm after blunt trauma have been reported,3,4 but presentation thirty years after a blunt trauma chest is very rare. Management consists of surgical repair of the pseudoaneurysm with patch as mortality rate is very high in untreated cases.3 However, our pat ient re fused any surgica l intervention.