Massive left ventricular Pseudoaneurysm four weeks post-myocardial infarction and percutaneous coronary intervention: a case report.

Left ventricular pseudoaneurysms (LVPA) are rare complications of myocardial infarction (MI), occurring in less than 1% of cases. Diagnosis is challenging due to nonspecific symptoms, particularly in large aneurysms. Imaging modalities like echocardiography, CTA, and CMR are vital for identifying LVPA, especially in atypical presentations involving massive aneurysms. We report a 75-year-old male with chest pain, diagnosed with inferior wall MI due to left circumflex artery occlusion and treated with PCI. Four weeks later, echocardiography detected an aneurysmal outpouching, confirmed by CTA and CMR, which revealed an unusually large aneurysm with a 30-mm neck, thrombus formation, and extensive myocardial damage. Conservative management was chosen after the patient declined surgery. This case is significant due to the aneurysm's extraordinary size, emphasizing the role of multimodal imaging, particularly CMR, in diagnosis and management. Further research is needed to refine treatment guidelines for such complex cases.