A Rare Case of Undiagnosed Post-Myocardial Infarction Left Ventricular Apical Pseudoaneurysm

Mechanical complications following acute myocardial infarction (MI) are associated with very high morbidity and mortality. Left ventricular (LV) pseudoaneurysms constitute a rare complication after MI. Considered a contained rupture of the LV free wall, an LV pseudoaneurysm is more prevalent in older age, the female sex, hypertension, and inferior and lateral wall MI. Echocardiography, computed tomography, and cardiac magnetic resonance are considered good noninvasive imaging modalities for the diagnosis of LV pseudoaneurysms.

Case: 

A 39-year-old man with a history of anterolateral MI 18 months earlier, coronary stent insertion, and implantable cardioverter-defibrillator implantation presented for follow-up, but he was incidentally diagnosed with LV pseudoaneurysm in transthoracic echocardiography, which was confirmed by cardiac computed tomography.

Pseudoaneurysms must be diagnosed because of their high likelihood of rupture. However, as their clinical presentation is not specific, they are occasionally diagnosed incidentally. Clinicians should, therefore, always look for them in post-MI patients’ echocardiography.