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

Document Type : Case Report


1 Cardio-Oncology Department and Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, IR Iran.

2 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, IR Iran.


Introduction: 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.
Discussion: 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. (Iranian Heart Journal 2023; 24(1): 91-96)


  1. Goldweig AM, Wang Y, Forrest JK, et al: Ventricular septal rupture complicating acute myocardial infarction: Incidence, treatment, and outcome among Medicare beneficiaries 1999-2014. Catheter Cardiovasc Interv 2018:92:1104-15.
  2. Alapati L, Chitwood WR, Cahill J, et al: Left ventricular pseudoaneurysm: A case report and review of the literature. World J Clin Cases 2014: 2(4): 90-93.
  3. Pretre R, Linka A, Jenni R, et al: Surgical treatment of acquired left ventricular pseudoaneurysms. Ann Thorac Surg 2000:70:553–7.
  4. Otto CM: The practice of clinical echocardiography. Philadelphia, Pennsylvania: Elsevier publishing Co., Inc; 2017, P. 208.
  5. Frances C, Romero A, Grady D. Left ventricular pseudoaneurysm. J Am Coll Cardiol 1998: 32: 557-561.
  6. Covino E, Chello M, Di Sciascio G: Giant left ventricular pseudoaneurysm complicating an acute myocardial infarction in patient with previous cardiac surgery: a case report. J Cardiovasc Med (Hagerstown) 2009:10: 81-84.
  7. Gatewood RP, Nanda NC: Differentiation of left ventricular pseudoaneurysm from true aneurysm with two dimensional echocardiography. Am J Cardiol 1980:46: 869-878.
  8. Gill S, Rakhit DJ, Ohri SK, Harden SP: Left ventricular true and false aneurysms identified by cardiovascular magnetic resonance. Br J Radiol 2011: 84: e35-e37.
  9. Ghersin E, Kerner A, Gruberg L, et al: Left ventricular pseudoaneurysm or diverticulum: differential diagnosis and dynamic evaluation by catheter left ventriculography and ECG-gated multi detector CT. Br J Radiol 2007:80:209.
  10. Blazejewski J, Sinkiewicz W, Bujak R, et al: Giant post-infarction pseudoaneurysm of the left ventricle manifesting as severe heart failure. Kardiol Pol. 2012:70:85-7.