A Lifesaving Abdominal Pain: Unusual Presentation of Giant Coronary Artery Aneurysm among Multiple Aneurismatic Coronary Disease

Abstract

Coronary artery aneurysms are rare with a prevalence estimated between 0.3-5% among people undergoing angiography. Giant coronary artery aneurysms (CAA) defined as having a diameter of 2 cm or greater are rare with a reported prevalence of 0.02%. Combination of giant coronary aneurysm with multiple fusiform aneurysms in the remaining coronary arteries is even rarer. Giant CAAs are prevalent in adult male and predominant in right coronary artery; the etiology is atherosclerotic or associated with Kawasaki disease, Takayasu arteritis, collagen vascular disease, IgG4-related coronary periarteritis or secondary to drug-eluating stent implantation. Complications could be thrombosis of the aneurismal sac with secondary acute coronary syndrome or rupture of the sac with fatal consequences, but patients can be completely asymptomatic. We describe an interesting case of a 58 year-old man who had multiple atherosclerotic CAA, one of which was a giant CAA of the right coronary artery presenting to us claiming abdominal pain without any kind of cardiac symptoms.