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Pseudoaneurysm of the mitral–aortic intervalvular fibrosa presenting after chest trauma and diagnosed by cardiac magnetic resonance: a case report

Adriana Dias Barranhas123, Márcia Cláudia Dias2, Alair Augusto Sarmet Moreira Damas dos Santos123, Edson Marchiori3 and Marcelo Souto Nacif145*

Author Affiliations

1 Radiology Department, Federal Fluminense University School of Medicine, HUAP 2º andar, Rua Marquês do Paraná s/n., Centro - Niterói, RJ, Brazil

2 ProEcho Cardiodata Serviços Médicos, Unidade Niterói, Rua Jornalista Moacir Padilha 195, Centro - Niterói, RJ, Brazil

3 Radiology Department, Rio de Janeiro Federal University, Rua Professor Rodolpho Paulo Rocco, 255. – Ilha do Fundão, Rio de Janeiro, RJ, Brazil

4 Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Drive, Building 10, BIN264B, Bethesda, MD, USA

5 Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock, Baltimore, MD, USA

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Journal of Medical Case Reports 2012, 6:357  doi:10.1186/1752-1947-6-357

Published: 19 October 2012

Abstract

Introduction

Annular subvalvular pseudoaneurysm is a rare example of left ventricle aneurysm described predominantly in young African people. These aneurysms are divided into two different types, namely, submitral or subaortic, with subaortic being the less frequent kind. The subaortic type is most often localized in the mitral–aortic intervalvular fibrosa. To the best of our knowledge, this is the first report of a mitral–aortic intervalvular fibrosa pseudoaneurysm associated with coarctation of the aorta, anomalous pulmonary venous return, bicuspid aortic valve and patent ductus arteriosus diagnosed by cardiovascular magnetic resonance.

Case presentation

We report the case of a 15-year-old African-American boy with a history of mild chest trauma who underwent echocardiographic evaluation as part of an out-patient work up. The echocardiogram was suspicious for the presence of mitral-aortic intervalvular fibrosa pseudoaneurysm and cardiovascular magnetic resonance was then performed to better characterize this finding. In addition to confirming the presence of the aneurysm, cardiovascular magnetic resonance also revealed coarctation of the aorta, a bicuspid aortic valve, and anomalous pulmonary venous return.

Conclusion

In our case, cardiovascular magnetic resonance was helpful in: (a) making a definite diagnosis of mitral–aortic intervalvular fibrosa pseudoaneurysm and its borders, which was not clear with an echocardiogram examination; and (b) illustrating additional associated congenital anomalies including the anomalous pulmonary venous return.

Keywords:
Heart defects; Congenital; Magnetic resonance imaging; Aneurysm