GIANT ANEURYSM OF THE INTERVENTRICULAR SE PTUM - VALUE OF IMAGING TECHNIQUES

A pseudosubaortic left ventricular aneurysm was discovered in a 32 yea r old African presenting with pyrexia after a long history of chest pa ins and dyspnea. Echographic and radiological techniques showed a larg e pulsatile mediastinal mass and the patient was referred for aneurysm orrhaphy. The actiology of this pseudo-aneurysm is discussed with refe rence to data in the literature. Infection is the first cause to be ex cluded in view of the pyrexia truncated by ''blind'' anti-inflammatory and antibiotic therapy. The hypothesis of an interventricular septal abscess secondary to septicaemia with secondary rupture into the peric ardium is discussed. Precessive endocarditis with an aseptic abscess i s unlikely because of the minimal aortic valve lesions, the absence of vegetations and the very long clinical evolution. Finally, idiopathic pseudo-aneurysms in sub-Saharian Africans, due to a congenital defect of the fibrous aortico-mitral and subannular zones must be considered . The risk of complications of these pseudo-aneurysms justifies surgic al intervention on the accurate anatomical description of the lesions provide by transthoracic and transoesophageal echocardiography and mag netic resonance imaging.