Background <p>Left ventricular pseudoaneurysm (LVP) is a rare complication, typically following a prior myocardial infarction. Clinical manifestations are diverse and non-specific, posing significant challenges for early diagnosis. Given the high risk of complete rupture, LVP is typically associated with poor prognosis, necessitating urgent surgery for survival. In the current LVP case, the patient presented with isolated chest pain, and further evaluation revealed non-obstructive coronary artery disease. To our knowledge, such cases are rare, and guidelines for LVP management—especially for chronic presentations—remain scarce.</p> Case presentation <p>A man in his 50s, complaining of recurrent chest pain over 8 months, was found to have a giant abnormal mass with rim calcification close to the posterior ventricle wall on chest computed tomography. Both contrast-enhanced echocardiography and cardiac magnetic resonance confirmed the diagnosis of a giant extensively calcified LVP in the inferolateral ventricle wall, as well as left ventricle enlargement and compromised systolic function. Coronary angiography revealed non-obstructed arteries. To prevent complete rupture, avoid systemic embolism, and improve cardiac function, the patient underwent successful surgical repair following a multidisciplinary team discussion and has achieved good subsequent recovery.</p> Conclusion <p>Our experience with successful surgical intervention in managing this unusual case of a chronic giant LVP provides compelling evidence that surgical repair should be considered a first-line treatment option for such patients.</p>