This report describes a case of left ventricular pseudoaneurysm diagnosed with two dimensional real time echocardiography. The two dimensional echocardiogram identified not only the pseudoaneurysmal sac but also the site of left ventricular rupture. When supplemented with radioisotope gated cardiac blood pool scanning, the noninvasive studies demonstrated combined true and false left ventricular aneurysms. Left ventricular pseudoaneurysm can be diagnosed using two dimensional echocardiography and nuclear imaging, permitting early operative intervention before fatal rupture.