case_images: PMC5587959_01
case_images: Portable chest X-ray. Minimal cardiomegaly and minimal interstitial pulmonary vascular congestion. Possible small right pleural effusion.
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case_images: fig1
case_images: Chest X-ray demonstrated interstitial pulmonary vascular congestion (Figure 1), and EKG was sinus tachycardia with first-degree AV block.
case_images: Transthoracic echocardiogram. Small, 5 mm ventricular septal defect in the distal inferoseptal/apical septum (red arrow).
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case_images: fig2
case_images: TTE demonstrated normal biventricular systolic function, grade 2 diastolic dysfunction, and a small, 5 mm distal inferoseptal/apical VSD (Figure 2).
case_images: CT pulmonary angiogram.  6.4 x 4.3 cm peripherally calcified hyperattenuating lesion along the intraventricular groove highly concerning for a giant left anterior descending coronary artery aneurysm (red arrow).
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case_images: fig3
case_images: CTPA was without evidence of pulmonary embolism but did demonstrate a 6.4 x 4.3 cm calcified lesion concerning for giant LAD coronary artery aneurysm (Figure 3), though image quality was limited by lack of gating.
case_images: Left heart catheterization. Mild luminal irregularities of the left anterior descending artery and left circumflex arteries not requiring percutaneous intervention. No evidence of aneurysm.
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case_images: fig4
case_images: Coronary angiography revealed mild luminal irregularities only, with normal ejection fraction and no evidence of LAD aneurysm (Figure 4).
case_images: Cardiac MRI.  5.4 x 4.1 x 4.9 cm pseudoaneurysm arising from the mid-apical free wall of the right ventricle, with a 9 mm neck (red arrow). There is an adjacent muscular ventricular septal defect, which is likely related.
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case_images: fig5
case_images: Follow-up imaging was performed to elucidate these findings, and cardiac magnetic resonance imaging (MRI) clarified the anomaly as a 5.4 x 4.1 x 4.9 cm pseudoaneurysm arising from the mid-apical free wall of the RV with a 9 mm neck (Figure 5).
case_images: Cardiac CTA. Pseudoaneurysm arising superiorly from the mid-apical free wall of the right ventricle measuring up to 6.1 cm in maximal diameter with a 15 mm neck (red arrow).
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case_images: fig6
case_images: Cardiac CT angiogram was well performed and confirmed pseudoaneurysm arising superiorly from the mid-apical free wall of the RV measuring up to 6.1 cm in maximal diameter with a 15 mm neck as well as 4 x 11 mm mid-apical VSD (Figure 6).
case_images: CT pulmonary angiogram. An old healed rib fracture anterior to the pseudoaneurysm (red arrow).
case_images: CRIC2017-4352474.007.jpg
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case_images: fig7
case_images: A review of the previously performed CTPA was conducted at this point and revealed a previously healed rib fracture anterior to the pseudoaneurysm (Figure 7).