Hidden in Plain Sight: Enhanced Decision Making in an Unstable Patient

The use of ultrasound enhancing agents (UEA) help optimize visualization in technically difficult studies, with improved left ventricular opacification and endocardial border definition. The use of these agents may often unveil critical data that drastically alter clinical management. Despite the clinical benefit of using UEA, it is sometimes not used routinely in emergency situations with an unstable patient for many reasons. Herein, we demonstrate a challenging case of late presentation myocardial infarction complicated with cardiogenic shock and pseudoaneurysm formation that was not observed in non-contrast images emblematically demonstrating how the use of ultrasound enhancing agents can drastically impact clinical decision-making.