A 69-year-old female presented to the emergency department with chest pain and EKG changes consistent with anterior STEMI. Left heart catheterization revealed multi-vessel CAD. She was referred for a CABG. Transthoracic echocardiography (TTE) with contrast raised concerns for apical pseudoaneurysm (Image 1). Cardiac computed tomography (CT) confirmed the presence of a multi-lobular dissecting pseudoaneurysm and extensive pericardial thickening (Images 3 and 4). This was confirmed at surgery, and she underwent partial pericardiectomy. Repair of the defects was deemed too high risk and adhesion prevented the insertion of any grafts. She subsequently underwent percutaneous revascularization.

A 50 year old male with a history of myocardial infarction 3 months prior presents to the emergency department with shortness of breath. Diagnostic workup revealed a left ventricular pseudoaneurysm of the inferolateral wall. Coronary artery disease and mitral valve regurgitation were concomitantly identified. Surgical intervention on these issues was successful. This case report highlights a rare but important complication of myocardial infarction.