title: An apical left ventricular aneurysm rupture presenting as left breast mass 11 years after surgical repair.
abstract: Left ventricular (LV) pseudoaneurysm is a rare entity and, consequently, there is limited knowledge of the condition's natural history. The most frequent mode of presentation for LV pseudoaneurysm is heart failure with chest pain. However, the variable presentation of this condition requires a high index of suspicion for diagnosis. We report the case of a 75-year-old woman who had suffered an acute myocardial infarction 23 years previously, which resulted in a calcified LV apical aneurysm. Three weeks prior to being referred to our hospital, she was noted by her general practitioner to have a left-sided breast mass although mammography was negative. One week later, she attended the accident and emergency department; she was haemodynamically unstable but was resuscitated successfully. Contrast enhanced computed tomography showed a large haematoma located in the left chest wall communicating with the left ventricle. She underwent emergency cardiac surgical repair. On arrival at the intensive care unit following surgery, her haemodynamic status was unstable, and she deteriorated rapidly and died. With this report, we aim to raise the level of awareness for an apical LV pulsatile mass that could anatomically expand and present as a breast mass or tumour. An early diagnosis and timely surgical intervention is essential in order to achieve better outcomes and avoid detrimental complications.
authors.affiliation: Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: M
authors.initials: M
authors.lastname: Fok
authors.forename: M
authors.initials: M
authors.lastname: Bashir
authors.forename: I
authors.initials: I
authors.lastname: Hammoud
authors.forename: D
authors.initials: D
authors.lastname: Harrington
authors.forename: M
authors.initials: M
authors.lastname: Kuduvalli
authors.forename: M
authors.initials: M
authors.lastname: Field
authors.forename: A
authors.initials: A
authors.lastname: Oo
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D001943:Breast Neoplasms / Q000175:diagnosis*; D006348:Cardiac Surgical Procedures / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D003937:Diagnosis, Differential; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D006322:Heart Aneurysm / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D006352:Heart Ventricles; D006406:Hematoma / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis; D011859:Radiography; D016217:Ultrasonography, Mammary / Q000379:methods