Left ventricular pseudoaneurysm: A diagnostic dilemma

Cases of infective endocardits presenting per se as huge LV PA are rarely reported in the literature. A 30-year-old male with no cardiac risk factors presented with community-acquired pneumonia and sepsis and shock. Chest X-ray revealed bilateral consolidation. A huge bulge was noted on the left ventricular border. Electrocardiogram did not reveal any ischemia or infarction. A transthoracic echocardiogram showed an aneurysm-like structure communicating with the left ventricle free wall below the mitral valve suggestive of LV pseudoaneurysm with severe mitral regurgitation. This was confirmed by a computed tomography scan. No vegetation was noted. He was treated aggressively with intravenous broad-spectrum antibiotics and inotropes but was in persistent shock. Cardiac surgery was considered, but the patient and relatives refused. Finally, he went into refractory shock and expired. The dilemma was the cause for this presumably acute-onset PA. There was no clear-cut evidence of endocarditis, though this appears to be the etiology in this patient.