Unruptured giant left ventricular pseudoaneurysm complicating silent myocardial infarction in a diabetic young adult - Left ventricular giand pseudoaneurysm after silent myocardial infarction

We report a very rare case of a 36-year-old diabetic man who had a silent myocardial infarction, a ruptured myocardial wall, and an unruptured left ventricular pseudoaneurysm. The patient admitted with a 3-month history of dyspnea on exertion, without evidence of acute coronary syndrome. Coronary angiography showed severe stenosis of the right coronary artery. Echocardiography, multiple gated acquisition radionuclide scan (MUGA) and left ventricular angiography revealed giant left ventricular posterolateral pseudoaneurysm next to the left ventricle. Patient underwent to surgery with excellent results. We present this case because rarity and high clinical index of suspicion is needed to avoid missing the diagnosis in such an unusual sequence of silent myocardial infarction in diabetic patient. The clinical picture of dyspnea in a diabetic patient in presence of a diagnostic echocardiographic finding warrants coronary angiography to document the ischemic etiology of the pseudoaneurysm in view of prompt surgical correction.