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Left ventricular pseudoaneurysm is a rare but dangerous complication, which occurs in the early post myocardial infarction period. Small pseudoaneurysms are not fatal, while large ones cause death due to sudden rupture and cardiac tamponade if surgery is not performed on time. As left ventricular pseudoaneurysm is uncommon in population, only few case reports were found in the published literature. In this article, we present a case of left ventricular pseudoaneurysm in a 79-year-old female patient after a silent posterolateral myocardial infarction, which increased to gigantic size for 3 months and was diagnosed accidentally by transthoracic echocardiography. Since the patient refused surgical treatment, the difficulties in deciding on the management of the patient based on a review of the literature is described. The main goal of this case is to describe the 6-month survival rate of a 79-year-old female patient with left ventricular pseudoaneurysm after silent posterolateral myocardial infarction despite refusal of surgical treatment and extremely low adherence to drug treatment due to cognitive impairment.