A Ring in the Heart Calcified Left Ventricular Aneurysm
A 75-year-old man had a smoking habit of 60 cigarettes per day. Eighteen years ago, he had an anterior wall myocardial infarction. Seven years ago, he had a stroke with left hemiparesia that improved completely in the next few weeks. After that, he remained in functional class II, and he did not complain of dyspnea or angina.
One year ago, the patient was admitted to the hospital because of mild dyspnea. He did not have dizziness or sincopal episodes. A complete atrioventricular block was diagnosed with a ventricular rate of 33 bpm. The fluoroscopic image during pacemaker implantation revealed a calcified ring in different projections, related to an anteroapical calcified aneurysm. He was discharged and continued asymptomatic, walking 3 km in 50 to 60 minutes 3 times a week. Recently, he presented because of transient cerebral ischemic attacks. A chest x-ray showed a peculiar oval calcified image related to a left ventricle aneurysm (Figures 1 and 2⇓). On the basis of a previously published noncontrasted computed tomography scan of a patient with a calcified left ventricular aneurysm which did not confirm a possible partly calcified apical thrombus,1–2 we performed a contrasted computed tomography scan, which showed the calcified aneurysm and a mural apical thrombus with calcifications that suggested an old thrombus (Figure 3).