A 67-year-old male, hypertensive, and smoker presented with progressive shortness of breath (NYHA Class II) of 4 months duration. He gave a history suggestive of acute coronary syndrome 6 months back but he did not seek any medical attention. Clinical examination revealed an apical short systolic murmur. Electrocardiography showed Q waves in inferior leads. 2D echocardiography revealed concentric LVH and a large defect in the posterior wall of left ventricle (LV), [Figure 1] and [Figure 2], [Video 1] - and [Video 2]- measuring 91 mm x 58 mm collapsing with each diastole and expanding during systole indicature of Pseudoaneurysm. Coronary angiography showed triple vessel disease with chronic total occlusion of proximal right coronary artery. It also showed expansile pseudoaneurysm arising from the posterolateral wall of LV [Figure 3]a and b, [Video 3].- LV function was severely reduced. He underwent successful coronary artery bypass graft surgery with aneurysmectomy. Left ventricular (LV) free wall rupture is a potentially lethal mechanical complication after myocardial infarction (MI). Echocardiography is a very sensitive and specific imaging modality not only in diagnosis but also in evaluating complications related to it.
Figure 1: Transthoracic 2D echocardiography in modified 2 chamber view showing defect in the posterior wall of LV with large pseudoaneurysm. Arrows show neck of aneurysm. (LV = left ventricle; LA = Left Atrium; PAN = Pseudoaneurysm; S = Septum)
Figure 2: Transthoracic 2D echocardiography in parasternal short axis view showing pseudoaneurysm. Arrows show neck of aneurysm, which is narrower than the maximal internal diameter of the aneurysm. (LVPW = Left ventricular posterior wall)