On a frontal chest radiograph of an adult, a well-defined rounded opacity projects over the left cardiac border just below the aortic knuckle, continuous with the mediastinal soft tissue, and contains curvilinear peripheral calcification. The patient had a myocardial infarction five years ago. What is the most likely diagnosis?

• A Pericardial cyst
• B Calcified left ventricular aneurysm ✓
• C Mitral annular calcification
• D Calcified mediastinal lymph node

Explanation

B left ventricular aneurysm after infarction appears as a focal bulge of the left cardiac border, usually anterolateral or apical, often with curvilinear rim calcification developing over years. Its continuity with the cardiac silhouette and the infarct history separate it from a pericardial cyst, which is a water-density mass typically at the right cardiophrenic angle without calcification.

Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.

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