Large basal inferior wall aneurysm with thrombus: a rare phe
The present case has been reported in BMJ.

An 80-year-old man, non-diabetic, non-hypertensive and smoker presented with history of shortness of breath on exertion for last 3–4 months. There was no history suggestive of an acute coronary event. ECG revealed significant Q waves in inferior leads with minimally elevated, ‘coved’ ST segment.

Echocardiogram revealed hypokinesia of inferior wall and a large basal aneurysm (4.9×4.4 cm) with a thrombus in it (size ∼2.6×4.4 cm; figures 1 and 2). There was ‘spontaneous echo contrast’ in left ventricle (LV) near the aneurysm.

Learning points
• Aneurysms of basal inferior wall of left ventricle are rare and difficult to detect on transthoracic echocardiogram.

• In case of clinical suspicion, patient should be subjected to contrast echocardiogram or MR scan.

• Cardiac MRI is the best modality for preoperative assessment of left ventricle aneurysm.

• Basal inferior wall aneurysms constitute nearly 3% of all LV aneurysms, and large thrombus in these aneurysms is a rare phenomenon.

• Besides atherosclerotic coronary artery disease, other uncommon causes of LV aneurysm include hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, myocarditis, coronary artery fistula, chest trauma, infections like Chaga's disease and HIV, and connective tissue diseases like sarcoidosis and systemic lupus.

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