Single photon emission computed tomography radionuclide ventriculography in the noninvasive diagnosis and evaluation of a false left ventricular aneurysm (pseudoaneurysm).

An inferior wall false aneurysm (pseudoaneurysm) was diagnosed in a 77-year-old male by single photon emission computed tomography (SPECT) radionuclide ventriculography (RNV). This immediately followed routine planar RNV because the latter did not lead to definitive characterization of the type of aneurysm and did not ideally characterize the location and size of the aneurysm. RNV was followed by false-negative first-pass radionuclide ventriculography, routine echocardiography, and gated magnetic resonance imaging of the heart (cardiac MRI). A definitive diagnosis of a false aneurysm is found at surgery and pathology; however, the patient declined surgery and has done well for 1.5 years after these imaging studies. The first-pass study is limited with relatively small pseudoaneurysms, like in this case. Echocardiography is noninvasive and can show wall motion and aneurysm size. Cardiac MRI is the most expensive noninvasive study but, in addition to revealing the diameters of the neck and body of the aneurysm, MRI is able to characterize the surrounding myocardium. This case report suggests the critical information needed for a confident, noninvasive diagnosis of false aneurysm can be obtained with SPECT RNV. The location of the aneurysm is easily determined, and the relative diameters of the neck to the body of the aneurysm can be easily seen. SPECT RNV is superior to planar RNV and first-pass radionuclide ventriculography in making a diagnosis of false aneurysm. Although RNV might be unable to directly demonstrate the perfusion and thickness of the myocardium, it has an advantage over MRI in terms of ejection fraction (EF) and cost.