Left atrioventricular groove pseudo-aneurysm demonstrated by multimodality imaging

A 41-year-old male was admitted because routine chest computed tomography (CT) examination revealed possible pericardial mass. The patient was asymptomatic and had history of cured tuberculosis. He denied risk factors for coronary artery disease and any history of traumatic injury. Electrocardiogram and cardiac enzymes were normal. Echocardiography showed severe mitral regurgitation and doubtful left atrioventricular groove pseudo-aneurysm (Panels A and B). Coronary CT angiography demonstrated that a calcified aneurysm communicated with left atrioventricular cavity through near posterior mitral valve defect (Panels C, D, F, G, and H), and coronary arteries were unobstructed with no atherosclerotic lesion (Panel E). The size of aneurysm was 4.6 × 3.1 mm. Balanced steady-state free procession cine magnetic resonance imaging (MRI) showed flow between the left atrioventricular cavity and aneurysm sac (Panels I, J, and K; see Supplementary material online, Movies S1 and S2). Black blood T1 weighted imaging demonstrated aneurysm sac in the left atrioventricular groove segment (Panel L). First pass perfusion MRI showed almost simultaneous visualization of left ventricular cavity and aneurysm sac (Panel M; see Supplementary material online, Movies S3). Late gadolinium enhancement MRI showed diffuse pericardial enhancement surrounding aneurysm sac (Panel N). The patient was finally transferred for cardiac surgery, and urgent surgical repair was considered.