Left Ventricular True Aneurysm: Cardiac Ct Angiography Diagnosis and Differentiation From Pseudoaneurysm

Left ventricular true aneurysms (LVTA) are uncommon, but clinically significant sequelae of myocardial infarction (MI), most frequently arising weeks to months after transmural infarction due to progressive ventricular remodeling and scar formation. Accurate differentiation from left ventricular pseudoaneurysm (LVPA) is critical, as LVPA represents a contained myocardial rupture with a substantially higher risk of fatal rupture, often necessitating urgent surgical repair. LVTA, in contrast, is generally more stable and can be managed conservatively in selected cases. We report a case of a 68-years-old male with a history of anterior ST-elevation MI who presented with progressive exertional dyspnea. Cardiac CT angiography (CTA) was performed for further evaluation, and it demonstrated a large anterolateral LV outpouching with a broad neck (orifice-to-cavity diameter ratio of ~0.9), preserved myocardial continuity, traceable coronary arteries along the aneurysmal wall, and traceable mural calcifications - features consistent with chronic LVTA. No pericardial effusion, mural thrombus, or signs of rupture were present. This case underscores the diagnostic value of CTA in characterizing LV outpouchings, particularly when echocardiography or MRI is unavailable or inconclusive. CTA offers high spatial resolution, multiplanar assessment, and precise measurement of the aneurysm’s neck and cavity, enabling confident differentiation between LVTA and LVPA, guiding clinical decisionmaking and preventing unnecessary urgent surgery.