A 14 year old girl presented with a history of fatigue, atypical chest pain, and breathlessness for one month. Her haemoglobin was 8.3 g/dl and erythrocyte sedimentation rate (ESR) was 48 mm in the first hour. She had an anterolateral myocardial infarction on ECG. Her echocardiogram revealed a large pseudoaneurysm of the mid and apical lateral left ventricular free wall. On cardiac catheterisation, the presence of large anterolateral left ventricular pseudoaneurysm was confirmed (panel A). It also showed constriction of the aortic arch, with a gradient of 30 mm Hg across it, ectatic changes in arch vessels, and diffuse irregularity of the descending thoracic and abdominal aorta (panel B). Coronary angiogram revealed distal left anterior descending artery occlusion. The patient was diagnosed as having active non-specific aortoarteritis with involvement of coronary arteries with myocardial infarction. She underwent resection of the pseudoaneurysm and was started on steroids. The resected tissue revealed ischaemic changes. She was doing well at three month follow up.

Left ventriculogram in right anterior oblique position showing presence of a large anterolateral pseudoaneurysm.

Aortogram showing diffuse irregularity of the descending thoracic aorta and upper abdominal aorta.