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.