A 60 year old gentleman was transferred to a regional hospital following an admission for non-ST elevation myocardial infarction (NSTEMI) complicated by true left ventricular apical aneurysm and pyopericardium. During admission he had delayed rupture of the aneurysm leading to the development of a concurrent pseudoaneurysm – a rare event. The onset of pseudoaneurysm was difficult to determine as the patient was asymptomatic, and limited access to cardiac CT (computerised tomography) and cardiac MRI (magnetic resonance imaging) made diagnosis difficult.