A 67-year-old male smoker was seen in the ER for evaluation of cough and treated for acute bronchitis. A CXR done at that time prompted a referral to the chest clinic. The patient gives a past history of myocardial infarction, but at the moment is asymptomatic. BP is 128/80 and cardiopulmonary exam is unremarkable. PPD is 7 mm. CXR is shown in. The likely diagnosis is

This AP lordotic view accentuates middle and anterior mediastinal structures. There is a convex outward opacity in the region of the left ventricle with a peripheral rim of calcification. It is contiguous with the cardiac shadow and represents a left ventricular aneurysm. Left ventricular aneurysm is usually secondary to myocardial infarction and may calcify. A true aneurysmal dilatation occurs anterolaterally and may require elective surgery. False aneurysms occur posteriorly and usually signify a contained rupture, which requires emergent surgical resection. In this case, the chest x-ray and the history of previous myocardial infarction make option d the best answer.