A 69-year-old female presented to the emergency department with chest pain and EKG changes consistent with anterior STEMI. Left heart catheterization revealed multi-vessel CAD. She was referred for a CABG. Transthoracic echocardiography (TTE) with contrast raised concerns for apical pseudoaneurysm (Image 1). Cardiac computed tomography (CT) confirmed the presence of a multi-lobular dissecting pseudoaneurysm and extensive pericardial thickening (Images 3 and 4). This was confirmed at surgery, and she underwent partial pericardiectomy. Repair of the defects was deemed too high risk and adhesion prevented the insertion of any grafts. She subsequently underwent percutaneous revascularization.