Idiopathic 'true' left ventricular aneurysm

We report the case of a 67-year-old patient who presented with anginal symptoms to the hospital. Computed tomographic angiography, to rule out a pulmonary embolism, showed a left ventricular apical outpouching. The patient underwent further imaging modalities, including contrast echocardiography (TTE) and cardiovascular magnetic resonance imaging (CMR), which were suggestive of a true left ventricular aneurysm (LVA). The absence of obstructive coronary artery disease on coronary angiography, absence of late enhancement on the CMR, and ultimately the intraoperative findings during surgical resection of the aneurysm, were strong indicators of a non-ischemic etiology of the patient's LVA. Additionally, the patient denied any previous history of cardiac instrumentation to rule out iatrogenic causes of LVA and congenital causes were excluded by a previous echocardiogram. Finally, history and presenting electrocardiogram did not reveal any other underlying obvious causes for the LVA. Excluding all common causes for the LVA an idiopathic cause seemed most likely.<. Learning objective: Patients with an idiopathic left ventricular aneurysm are at risk for life-threatening ventricular arrhythmias and sudden death, which may sometimes occur as the first clinical presentation. Echocardiography, cardiovascular magnetic resonance imaging, and cardiac contrast angiography can reliably detect the location, extent, and morphology of the aneurysm. Management strategies should be individualized and are mainly directed toward prevention of sudden death and recurrent arrhythmias.>.