Figure 3.

Cardiac MRI panel. (A) STIR image, two-chamber view. Large bulging aneurysmal sac containing a crescent of thrombus that appears black in these images (arrow). Of note, in the adjacent triangular thrombus (*) which lies in the pericardial space. This indicates that blood has travelled through the myocardium and a free wall rupture has occurred. (B) STIR image, oblique left ventricular outflow tract view. Thrombus can be seen surrounding the inferior wall of the left ventricle and crucially extends beyond the ventricle to the atria (arrows). The thrombus is therefore not contained within the ventricle and again indicates thrombus in the pericardial space and a diagnosis of LVFWR. (C) MAG1 short axis view. The extent of the aneurysm is illustrated with a dotted line that encompasses the usual contour of the left ventricle. The arrow indicates where a disturbance in the left ventricular wall can be visualised as an irregular ‘step-down’. This is the sight of sealed LVFWR. (D) STIR image, short axis view. The same discontinuity in the left ventricular wall can be seen in this image in the same area. In addition, the arrow indicates a thrombus adherent to the site of rupture that is lying in the pericardial space. It is this clot that has sealed the left ventricular free wall and prevented further bleeding. A, atria; V, ventricle; STIR, short τ inversion recovery; LVFWR, left ventricular free wall rupture.