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A 57 year old man was referred because of non-anginal thoracic pain. He had been involved in a frontal car accident two years earlier, resulting in multiple bilateral rib fractures, bilateral pneumothorax, rupture of the spleen and liver, and fracture of a femur. Splenectomy, raphy of the liver, bilateral thoracic drainage, and osteosynthesis of the femur were performed. Although recovery was uneventful he kept complaining of daily thoracic pain. His ECG at rest displayed a normal sinus rhythm. Radiography of the chest revealed focal bulging of the left midventricular border (panel A, arrow). Ventriculography demonstrated a left ventricular aneurysm of the mid anterior wall (panel B, arrow). Coronary arteries remained angiographically normal. Demonstration of myocardial lining of the aneurysm by magnetic resonance imaging proved it to be a true aneurysm (panel C, arrows indicate myocardial thinning and delayed hyperenhancement).
Post-traumatic cardiac aneurysms are rare. A temporary coronary obstruction has been suggested as a potential mechanism. True ventricular aneurysms have been treated surgically as well as medically. However, prospective randomised studies comparing these treatments are lacking. The patient has been treated medically for two years and his outcome has remained uneventful.
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