Pseudoaneurysms of the LV are rare complications of myocardial infarction. The pathogenesis results from microperforation and contained rupture of the LV occurring at the time of the acute myocardial infarction. The overlying adherent pericardium over the clots prevent from free rupture, then a pseudoaneurysm will develop. No specific symptoms of the LV pseudoaneurysm have been described. While patients may be asymptomatic, they can also present with symptoms of heart failure or atypical chest pain [
1].
The diagnosis of LV pseudoaneurysm is usually made by echocardiography and/or left ventriculogram, but establishing the diagnosis can be difficult. One study showed that 10% of LV aneurysms were diagnosed incidentally [
1]. Left ventriculography is the gold standard for LV pseudoaneurysm diagnosis and provides a definitive diagnosis in more than 85% of patients [
1]. Transesophageal echocardiography can be an alternative method to diagnose LV pseudoaneurysm with a diagnostic accuracy of 75%. [
1,
2].In contrast, it is often difficult to diagnose LV pseudoaneurysm with transthoracic echocardiography. In such a setting, cardiac MRI could be helpful to distinguish myocardium form thrombus [
2].
Previously, the usefulness of CT scan for detecting LV aneurysm has been limited because of artifact created by cardiac motion. However, in the case presented, advances in the CT scan technology allowed us to make a correct diagnosis of LV pseudoaneurysm. Our patient underwent contrasted CT scan to rule our intraabdominal lesion due to persistent epigastric pain. The CT scan interestingly disclosed LV pseudoaneursym without intraabdominal lesion. Epigastric pain of this case was most likely from the compression effect due to the LV pseudoaneurysm. The contrasted 16 slice successfully provided a precise image of the pseudoaneurysm, which was subsequently confirmed with left ventriculography. Contrast CT should be considered an alternative, non-invasive modality for diagnosing LV pseudoaneurysm.