Case report
An 87 year-old woman with hypertension, diabetes, coronary artery
disease, and an ischemic cardiomyopathy presented with acute coronary
syndrome and cardiogenic shock. Prior to abrupt clinical deterioration,
she had described angina and heart failure symptoms of two weeks’
duration. On presentation, she was hypotensive requiring vasopressor
support along with laboratory evidence of multiorgan failure.
Electrocardiography demonstrated biventricular paced rhythm with a
lateral wall infarct.
She was admitted to the cardiac intensive care unit and a bedside
transthoracic echocardiogram revealed apical and lateral wall akinesis
as well as aortic valve thickening. Due to suboptimal visualization of
the LV and anticipated need for mechanical circulatory support, UEA was
administered to exclude LV thrombus prior to proceeding with coronary
angiography. The bedside echocardiogram revealed possible pericardial
effusion versus a prominent pericardial fat; however, with the use of
UEA, a large, expansive lateral wall pseudoaneurysm with a narrow neck
width of 1.1 cm was revealed (Figure 1).
UEA also opacified the pericardial space, revealing a large pericardial
effusion with extensive thrombus.