Calcified ventricular aneurysm.

Left ventricular aneurysm (LVA) is defined as a distinct area of abnormal left ventricular diastolic contour with systolic dyskinesia or paradoxical bulging. A False aneurysm is defined as a rapture of the left ventricular wall enclosed by a surrounding pericardium, with an incidence rate of 10-35% of developing a myocardial infarction, depending on methods used for diagnosis and definition.1,2 A 70 year old male patient was presented at Sultan Qaboos University Hospital in Salalah with a history of increasing shortness of breath and a cough producing a white coloured sputum over the last 2 weeks prior to admission. The patient also had a history of orthopnea and paroxysmal nocturnal dyspnea for the 2 days prior to admission. For two years prior to admission, the patient had experienced shortness of breath on performing ordinary activities, and swelling of both legs over the last 2 months. However, the patient had no chest pain, no palpitation, no dizziness, no chest pain on effort and no history of dysuria. The patient was known to suffer from Coronary Artery Disease and experienced a myocardial infarction (MI) 10 years back where a coronary artery bypass surgery (CABG) was performed. The patient also had a history of diabetes and hypertension but was on irregular treatment and irregular follow up. On admission, the patient was dyspnoic, and his complexion had turned earthy in colour. The patient was also presented with bilateral leg oedema, raised JVP, his BP was 140/80, PR was 90 B/min, temp was normal at 37oC, normal heart S1, S2 and systolic murmur. Chest bilateral basal crepitation and abdomen palpable liver were also observed. Investigations showed Serum creatinine was 369.8mmol/L, urea 32.47mmol/L, K 3.27mmol/L, Na 128 mmol/L, Glucose 6.38mmol/L Ca 2.23mmol/L, Ph 1.1mmol/L Hb 13.4g/dl, wbc 7.74, AST 60.8U/L, ALT 59.4U/L, bill 34.3 PT 22.8 seconds, INR 1.63. Urine exam revealed no glucose or protein in the sample, a white blood cell count of <4cell in a 24 hr collection of urine, 198mg/24 hours of protein and 0.117 ng/ml of Troponin Chest x-ray revealed a PA and left lateral cardiomegaly, calcified lesion on the left lower part of the chest and differential diagnosis for the calcified lesion was suggestive of either calcified ventricular aneurysm or a calcified thrombus, (Figure 1, 2). Figure 1: Chest X-ray