The patient did not have a known history of coronary artery disease (CAD) but was at high risk for CAD due to the history of tobacco and drug use. He was referred to cardiology for further investigation and management.
Differential diagnosis:
Not a coronary artery aneurysm or a hydatid cyst or calcified fibroma based on CTA findings.
Since it is internal with no focal outpouchings, it is more likely a calcified thrombus rather than an apical calcified LV aneurysm.
The patient was referred for an echocardiogram and cardiac MRI.