A crescent-shaped image in the heart: calcified thrombosed left ventricular aneurysm.

A 60-year-old woman, who had a smoking habit of 30 cigarettes per day, was admitted for evaluation of effort angina and shortness of breath. Her medical history was unremarkable except for a syncopal episode experienced 15 years before that had not been investigated. Electrocardiographic tracings showed evidence of an old anterior myocardial infarction. Chest radiographs showed a peculiar crescent-shaped calcification enclosed within an abnormal cardiac silhouette, which suggested a left ventricular (LV) aneurysm containing an extensively calcified mural thrombus (Fig. 1). A transthoracic echocardiogram revealed a hyper-reflective aneurysm of the LV involving the apex, the septum, and the inferior wall, with a large calcified mural thrombus in the ventricular cavity. A coronary arteriogram showed an occlusion of the mid portion of the anterior branch of the left coronary artery and a critical stenosis of the proximal circumflex coronary artery. Fig. 1 Chest radiograph shows a dense opacity (arrow) at the anteroapical level of the left ventricle. The patient underwent an uneventful myocardial revascularization procedure in association with excision of the calcified LV aneurysms and the calcified mural thrombus, along with reconstruction of the ventricular wall as described by Cooley.1