Coronary pseudoaneurysm: an uncommon cause of P.U.O. after a common procedure: an interesting case report

Pyrexia 2 months after a coronary procedure is usually an unrelated event; we came across a rather uncommon cause of delayed appearance of fever related to subacute development of pseudoaneurysm and pericardial effusion secondary to leakage from the pseudoaneurysm after primary angioplasty of LAD, and to the best of our knowledge pseudoaneurysm leak as a cause of prolonged pyrexia is not reported in the literature. Two and half months after successful primary angioplasty with stent implantation for an acute myocardial infarction, we were confronted with an unexplained fever of prolonged duration, after extensive work the cause of unexplained pyrexia was found to be related to development of hemorrhagic pericardial effusion secondary to leak from coronary pseudoaneurysm. The pseudoaneurysm was located in ostium of left anterior descending coronary artery. Despite review of the literature and an examination of the procedural data, we were unable to explain the cause of pseudoaneurysm formation. We assume that either the guidewire perforated the arterial wall when it passed the occlusion or a dissection not visualized angiographically, provoked this phenomenon.