Case presentation
An 18-year-old previously healthy female presented to our department for
incidental detection of a giant cystic cavity on the left posterior part
of the heart by transthoracic echocardiography (TTE). The patient was
asymptomatic, laboratory tests were unremarkable, and physical
examination only found that the cardiac boundary expanded to the left.
To further delineate the anatomy of this large cavity and its
surrounding structure, this patient underwent contrasted CT and MRI. CT
results revealed that left atrial appendage (LAA) was significantly
enlarged, with a maximum cross-sectional length of 102mm and a width of
81mm (Figure 1). MRI results showed that the cystic structure with
slightly long T1 and long T2 signal is connected with the left atrium,
and the adjacent structure is compressed (Figure 2). Based on the
patient’s past health status and imaging findings, the patient was
diagnosed with congenital LAAA.
Considering the size of the giant aneurysm and the potential risk of
adverse events, the patient was suggested to take surgical removal of
the aneurysm. Aneurysmectomy was performed through median sternotomy
with cardiopulmonary bypass, which could provide us with a clear and
still vision. Intraoperatively, a huge intrapericardial aneurysm (110mm
* 100mm) at the left rear of the heart was visualized, which is
connected with the basal part of the LAA. The diameter of the neck
between LAA and the aneurysm was about 20mm, and no mural thrombus was
found in the aneurysm.