LAUSR

Background: Left ventricular (LV) pseudoaneurysm is a rare complication of myocardial infarction (MI) and difficult to diagnose. LV pseudoaneurysms form when cardiac rupture becomes contained within the pericardium. In those who survive the initial event, timely diagnosis is key as the condition often warrants emergency surgery. Case: A 78-year-old male with history of recent COVID-19 infection presented with pleuritic chest pain and near syncope. Chest computed tomography was notable for a large pericardial effusion as well as a hyperdense mass along the lateral aspect of the LV (Figure 1a). A transthoracic echocardiogram was performed;it showed significant wall motion abnormality of the lateral wall as well as a large, ill-defined pericardial or mediastinal echogenic dense mass impinging on the right atrium and ventricle. There was no evidence of tamponade physiology. Decision-making: Advanced imaging was required to further characterize the hyperdense mass. Cardiac MRI demonstrated a large, complex pseudoaneurysm emanating from the anterolateral wall of the LV with communication between the pseudoaneurysm and the pericardium (Figure 1b). MRI was also notable for full thickness delayed enhancement of the lateral wall consistent with infarction. Cardiac catheterization was notable for total occlusion of an obtuse marginal branch. Conclusion: This case highlights the importance of multi-modality imaging in detection of LV pseudoaneurysm, a potentially life-threatening complication of MI. [Formula presented]