Decade in hiding: chronic giant pseudoaneurysm after a coronary artery bypass grafting mimicking a double-chambered left ventricle

A woman in her early 60s with previous coronary artery bypass grafting 10 years earlier was incidentally found to have a cardiac opacity. Transthoracic echocardiography demonstrated a large posterobasal left ventricular outpouching communicating with the ventricular cavity and severe systolic dysfunction. Contrast-enhanced CT revealed a giant calcified left ventricular pseudoaneurysm measuring 9.0×7.5 cm, with a narrow neck and partial intraluminal thrombosis. Three-dimensional reconstruction demonstrated a striking double-chambered left ventricular appearance likely due to a chronic contained ventricular rupture related to prior surgery. However, a remote silent myocardial infarction could not be excluded. Patent bypass grafts and absence of significant native coronary artery disease favoured a postsurgical mechanism. Surgery was recommended but the patient declined intervention and was managed conservatively with medical therapy. She remained clinically stable at 12 months. This case highlights the value of multimodality imaging and individualised management in patients with complex, longstanding left ventricular pseudoaneurysms.