Introduction: Chagas disease is highly prevalent in Latin America and, due to migration, this condition is being diagnosed more frequently in developed countries. Trans-thoracic echocardiogram (TTE) is routinely used to evaluate these patients, in whom ventricular aneurysms (VA) are common. We aim to compare the accuracy of TTE vs. cardiac magnetic resonance imaging (CMR) as the gold standard for diagnosing VA. Methods: We performed TTE and CMR the same day in a prospective cohort of Chagas disease patients and no history of coronary artery disease. We classified VA′s according to their location and the apical ones were subclassified as follows: Microaneurysms (limited to the segment AHA-17), macroaneurysms (with extension to all apical segments), and giant aneurysms (with extension to midventricular segments). Results: A total of 79 patients were included. Of these, 57% were women with a median age of 60 years old (IQR 51-69) and a prevalence of VA of 24%. TTE had an overall sensitivity for VA of 47% (95% CI: 24 - 69%), specificity of 98% (95% CI: 95 -100%), positive predictive value of 90% (95% CI: 71 - 100%) and negative predictive value of 86% (95% CI: 77 - 93%) compared to CMR. Of notice, the TTE sensitivity for giant aneurysms was 100% (95% CI: 100 - 100%), for macroaneurysms was 54% (95% CI: 25 - 83%), and 0% (95% CI: 0 - 0%) for microaneurysms. Conclusions: The TTE sensitivity for VA in Chagas disease patients is limited and proportional to the size of the defect. Of notice, the specificity and positive predictive values are high. In patients with Chagas disease, CMR may be needed during the course of disease for optimal left ventricular wall characterization.