Chronic postinfarction pseudo-pseudoaneurysm diagnosed by cardiac MRI

Left ventricular pseudo-pseudoaneurysm is an extremely rare complication of myocardial infarction. In this condition the postinfarction rupture of the myocardium is not transmural, but remains circumscribed within the ventricular muscle itself as a cavity joining to the left ventricle through a narrow neck. The differentiation between postinfarction pseudoaneurysms and pseudo-pseudoaneurysms may be very difficult using conventional imaging techniques, such as transthoracic, or transesophageal echocardiography and left ventricular angiography. Cardiac MRI (CMR), however, is capable of distinguishing among anatomical structures such as pericardium, thrombus, and myocardium. In our report a chronic postinfarction pseudo-pseudoaneurysm is described by CMR in a patient with an old myocardial infarction.