Purpose. Assessment of the capabilities of modern imaging techniques in a patient with a left ventricular pseudoaneurysm to verify the diagnosis, differential diagnosis and to select the optimal treatment strategy.

Materials and methods. The patient aged 68 with a three-vessel coronary artery disease and previous posterolateral myocardial infarction 8 years ago initially selected an endovascular treatment strategy for sequential stenting of the coronary arteries. The first stage was performed with stenting of the right coronary artery, the second stage of endovascular treatment was planned next. However, repeated transthoracic echocardiography (TTE) revealed a defect of the posterolateral wall of the left ventricle and suspended the left ventricular pseudoaneurysm presence. The use of contrast enhanced TTE and multispiral computed tomography (MSCT) allowed to confirm the diagnosis and to detail anatomy and morphology of pseudoaneurysm.

Results. The detection of the left ventricular pseudoaneurysm made us to change the treatment strategy. An aneurysm resection with ventriculoplasty and coronary bypass surgery were performed.

True and false aneurysms (pseudoaneurysm) are complications of myocardial infarction. Discernment and differential diagnosis can be challenging. The contrast enchanced TTE allows to assess the localization of the defect, the condition and thickness of the walls of pseudoaneurysm, the presence of blood clots and visualize blood flow. MSCT contrast provides a detailed three-dimensional image of pseudoaneurysm, the ratio with the surrounding myocardium and pericardium, allows to estimate the ratio of aneurysmal neck and body, the thickness of the aneurysmal pouch walls and calcification burden, presence of blood clots, as well as to identify the extravasation of contrast in the pericardial cavity.

Conclusion. TTE can be considered as a first-line test for diagnosis, but this method is not characterized by high diagnostic accuracy due to the predominantly posterior localization of pseudoaneurysm, and further diagnostic search is required. Contrast ventriculography and coronary angiography are necessary to plan the extent of operation. In our case, the complex of modern research has provided accurate diagnosis and allowed for well-timed and successful surgery.