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The patient was a fit 14 year old boy with no known previous medical illness. He developed chest pains and shortness of breath while playing soccer but only sought treatment 18 hours later. His ECG showed Q waves in the anteroseptal leads with ST segment depressions in the lateral leads. Auscultation of the precordium revealed a pansystolic murmur. He subsequently underwent coronary angiography, which showed a large aneurysm of the proximal left anterior descending coronary artery (LAD) with TIMI 0 antegrade flow (below). There were multiple saccular aneurysms over the proximal and distal right coronary artery (top right). Left ventriculography showed a hypokinetic anterolateral wall with a large left ventricular pseudoaneurysm (bottom right). The patient underwent successful coronary artery bypass surgery with a left internal mammary artery to the LAD and the pseudoaneurysm was excised and repaired.