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Images in cardiovascular medicine. Right ventricular false aneurysm after unrecognized myocardial infarction 28 years previously.

A 74-year-old woman underwent an abdominal computed tomography scan for work-up of unclear recurring abdominal discomfort because abdominal ultrasound had not been diagnostic on account of a poor acoustic window and obesity (body mass index 31). Computed tomography did not detect any abdominal pathology but revealed an unclear mass located at a left anterior position on the cranial side of the diaphragm, most likely related to the apical portions of the heart (Figure 1). Thus, the patient was referred to our hospital for further cardiological work-up. 



Figure 1. Abdominal computed tomography scan with oral contrast agent. The unclear mass, located at a left anterior position on the cranial side of the diaphragm and related to the apical portions of the heart, is indicated by the arrowhead. Panels I to IV appear in cranio-caudal order.



Interestingly, the patient had been hospitalized twice at intervals of 4 months because of 2 episodes of severe chest pain 28 years previously, but no diagnosis could be made at that time. Routine ECG on admission revealed an abnormal electrical axis as well as high R-wave amplitudes in V2 and V3 (Figure 2). Consequently, additional right ventricular leads were obtained, demonstrating discrete ST-segment elevations (rV1 to rV4) and negative T waves (rV2 to rV6) (Figure 3), indicating possible right ventricular pathology. Because transthoracic echocardiography could …