Post-traumatic apical pseudoaneurysm: A diagnostic dilemma

Background Left ventricular pseudoaneurysms are uncommon but potentially life-threatening entities, often presenting with non-specific clinical symptoms and posing significant diagnostic challenges. Case Report We report the case of a 31-year-old female who presented with recurrent palpitations, chest pain, and exertional dyspnea 9 years after a traumatic fall. Initial workup with echocardiography suggested a possible pericardial or epicardial cyst, while coronary angiography excluded obstructive coronary artery disease but revealed abnormal contrast filling at the left ventricular apex. Subsequent computed tomography demonstrated a calcified apical mass, and cardiac magnetic resonance imaging raised suspicion for either a pseudoaneurysm or an echinococcal cyst, highlighting the diagnostic uncertainty. Given the risk of rupture, the patient underwent surgical exploration, which confirmed a large calcified apical pseudoaneurysm with intraluminal thrombi. The lesion was resected and repaired with a modified Dor procedure, and the patient's postoperative course was uneventful. Histopathological examination demonstrated chronic remodeling with hyaline-sclerotic and ossified changes, consistent with a traumatic origin. Discussion This case reflects the diagnostic complexity of apical pseudoaneurysms, which can mimic other cardiac or cystic pathologies. It emphasizes the critical role of multimodal imaging and histopathological analysis in distinguishing among traumatic, infectious, autoimmune, and congenital etiologies, and underlines the importance of timely surgical intervention to prevent catastrophic rupture.