Left Ventricular Pseudoaneurysm Dissecting into the Anterior Chest Wall: A Rare Cause of Sudden Onset Excruciating Chest Pain

Left ventricular pseudoaneurysm (LVPA) is associated with a significant mortality rate of up to 45% in the first year after diagnosis. It is a very rare entity and hence the true incidence and natural history are not clearly known. Clinical presentation varies widely and requires a high index of suspicion for diagnosis. We report the case of a 72-year-old woman with a remote history of left ventricular aneurysm repair during coronary bypass surgery who presented to the emergency department with acute onset of left-sided chest pain and a pulsatile chest wall swelling. She was haemodynamically stable but required an intravenous morphine drip for pain control. Contrast-enhanced computed tomography of the chest showed a large LVPA dissecting through the anterior chest wall. Surgical treatment was discussed with the patient but she opted in favour of comfort care. She died 5 days later from complete rupture of the LVPA. With this report, we aim to raise the level of awareness of LVPA that could anatomically expand and rupture. Early diagnosis and timely surgical intervention is the treatment of choice. LEARNING POINTS: It is important to recognize left ventricular pseudoaneurysm as a rare cause of sudden onset chest pain in a patient with history of myocardial infarction with/without coronary artery bypass grafting and presenting with a pulsatile chest wall mass on physical examination. Echocardiography is usually used for diagnosis, which is confirmed by CT or MRI of chest, while open surgical or percutaneous closure are the available treatment options. Mortality rates are very high even with surgical treatment in these complex patients.