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Radiographic appearance of a left ventricular apical aneurysm with thrombus following a large anterior myocardial infarction: “dumbbell” shaped heart

A 71-year-old patient with prior history of anterior my-ocardial infarction (MI) underwent coronary angiography toevaluate chest discomfort symptoms. The left ventriculogram(Figs. 1 and 2) revealed a large anterolateral, apical, and infer-olateral aneurysm with a filling defect occupying one-half ofthe aneurysm, consistent with a large apical thrombus. Ven-triculography was notable for the similarity of the patient’sventricle to the appearance of a dumbbell. In a recent analysis, Tikiz et al. noted that single-vessel dis-ease, absence of previous angina prior to infarction, total occlu-sion of the left anterior descending artery, and female genderwere independent determinants for the formation of aneurysmafter anterior MI. Coronary collateral status and risk factorssuch as hypertension, diabetes mellitus, hypercholesterolemia,and smoking were not found to be important determinants.