A 60 year old male with diabetes, hypertension, hyperlipidemia, peripheral arterial disease who presented with myocardial infarction 1 week ago and a pseudoaneurysm in the inferior wall was diagnosed in addition to 3 vessel coronary artery disease. The patient refused to have surgery and was referred to cardiac CT for follow-up of the pseudoaneurysmCPT Code: 75572 Left Ventricle: Normal LV size with low normal systolic function. The overall wall thickness is normal; however, a large complex appearing pseudoaneurysm (neck 11x12mm diameter and body with longest diameter 16mm) is noted. It appears to be larger than appreciated on the recent cardiac MRI but about the same size on the cardiac CT performed at outside hospital prior to the cardiac MRI. The aneurysm appears to have a couple of serpiginous extensions into the surrounding myocardium.Right Ventricle: Normal RV size with low normal systolic function.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. The superior vena cava is grossly normal. The inferior vena cava is dilated. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: Normal thoracic aorta and pulmonary artery size.Pericardium: no pericardial effusionCoronary arteries: Coronary artery assessment is limited because beta-blockers and nitrates were not administered as part of this study. The following observations are made within the limits of the study protocol.LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. The left main is without significant stenosis. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. The proximal LAD has an approximately 50% stenosis. There is non-obstructive atherosclerosis in the mid LAD. The distal LAD is not well seen due to severe calcification. LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There is severe calcification in the proximal vessel which prohibits adequate assessment of the lumen.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There is a severe stenosis in the proximal vessel. The mid vessel is completely occluded.
1. Normal LV size with low normal systolic function. A complex appearing pseudoaneurysm is noted in the basal inferior wall.2. Normal RV size with low normal systolic function.3. Mid RCA is occluded. Proximal RCA with severe stenosis. Proximal LAD with stenosis of intermediate severity. This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.