Silent Inferolateral Postinfarction Left Ventricular Outpouching With Thrombus: Cardiac Magnetic Resonance Assessment

Ventricular aneurysms (VAs) are rare complications of infarction. Inferolateral aneurysms with thrombus are uncommon and are often difficult to differentiate from pseudoaneurysms.

A 60-year-old man with diabetes, hypertension, and dyslipidemia was evaluated after incidental electrocardiographic evidence of inferior infarction and echocardiographic suspicion of pseudoaneurysm. Cardiac magnetic resonance revealed a large inferolateral VA with transmural fibrosis, preserved myocardial continuity, and an intracavitary thrombus. Coronary angiography showed diffuse right coronary disease with chronic occlusion of the posterolateral branch. Conservative management was chosen given transmural scar, absence of viability, unfavorable anatomy, and hemodynamic stability. Medical therapy included guideline-directed heart failure treatment, statin, and anticoagulation.

Inferolateral VAs with thrombus are rare postinfarction findings. Cardiac magnetic resonance provides anatomic delineation, thrombus detection, and distinction from pseudoaneurysm.

VAs with intracavitary thrombus are rare and often clinically silent. Cardiac magnetic resonance is the gold standard for differentiating true aneurysms from pseudoaneurysms and for detecting thrombus. Early identification, even in asymptomatic patients, is critical to guide therapy and reduce systemic embolic risk.