Large left ventricular pseudoaneurysm

Left ventricular pseudoaneurysm (LVPA) can complicate 4% of myocardial infarction ; it forms when rupture of the myocardium is contained by adherent pericardium or scar tissue. The diagnosis of a LVPA can be very difficult because of nonspecific signs and symptoms. Transthoracic twodimensional echocardiography (TTE) is the first applied investigation, although often can be non-diagnostic. TTE, contrast ventriculography, cardiac magnetic resonance (CMR) and three-dimensional echocardiography (3DE) are useful tools in pre-surgical assessment, allowing the differentiation between LV aneurysm and pseudoaneurysm, and the evaluation of LVPA size and spatial distribution. We report a case of a patient with a post-infarction LVPA that was detected initially by TTE and then cofirmed by ventriculography, 3DE and CMR. The patient was successfully treated surgically and then monitored by TTE.