CASE PRESENTATION: A 61 year-old Albanian male with a history of hypertension presented following an episode of syncope associated with lightheadedness, diaphoresis and nausea following a bowel movement. Upon presentation, vital signs were stable and physical exam was unremarkable. Initial laboratory testing showed eosinophilia and an elevated sedimentation rate. A transthoracic echocardiogram revealed an extracardiac thick-walled loculated cyst-like structure with partial compression of the left atrium and ventricle without hemodynamic compromise (EF of 55-60%). A CT of the chest revealed three well-circumscribed vascular masses with central vascular enhancement. The largest mass (5.3cm x 5.7cm x 10cm) was noted adjacent to the left atrium and ventricle in the course of the left circumflex artery (LCx). Cardiac catheterization showed three CAAs with possible arterio-venous fistulas. Cardiac MRI showed partially thrombosed LCx and RCA aneurysms and extensive mediastinal lymphadenopathy without any RV dysplasia noted. Given the loculated structure and eosinophilia, cardiac echinococcus was considered but the echinococcus antibody was negative. Rheumatological workup including ANA, p-ANCA and c-ANCA were negative. Surgical resection and repair of the LCx and RCA aneurysm along with quadruple coronary artery bypass grafting (CABG) was performed. Mediastinal lymph node biopsy was also performed but was negative for acid-fast bacilli or fungi or histo-pathological abnormality. Two post-operative incidents of sustained monomorphic ventricular tachycardiac (VT) were noted. Subsequently, an electro-physiology study performed which revealed inducible monomorphic VT. An implantable cardioverter defibrillator was placed for secondary prevention.