A left ventricular aneurysm (LVA) is a localized dyskinetic area of infarcted myocardium that bulges in systole and diastole. It is a well studied structural complication seen post myocardial infarction although decreasing in incidence due to major improvements in reperfusion therapy. Persistent ST elevation is the most widely reported electrocardiographic manifestation of left ventricular aneurysms. LVA may be evident on chest x-ray, as observed in this case. Diagnosis is non invasively confirmed using echocardiography. Complications of LVA include congestive heart failure, ventricular arrhythmias and rupture that can lead to sudden cardiac death. Surgical treatment is usually effective and followed by a marked improvement in function but is burdened with a heavy post operative mortality. We report the case of a 55-year-old man, with a history of myocardial infarction presenting with a large left ventricular aneurysm.