Left ventricular (LV) pseudoaneurysm is a rare complication of myocardial infarction with a high risk for mortality. The incidence has decreased in the era of early and aggressive revascularization. Surgical repair remains the cornerstone of treatment. We describe the case of a 72-year-old woman who presented for routine evaluation of atypical chest pain and was noted to have impressive findings of a chronic massive LV pseudoaneurysm with thrombus demonstrated through multimodality imaging. She was ultimately treated conservatively in view of her prohibitive surgical risk.