Abstract
Giant coronary artery aneurysms are a rare and potentially life-threatening condition. A 47 year old male presented with a progressive 6 month history of dyspnea and acute right sided chest pain. During the patients work-up, a 10 cm × 10 cm right coronary artery aneurysm was discovered on CT scan and confirmed by cardiac catheterization. The patient was emergently taken to the operating room for aneurysmal resection with placement of a greater saphenous vein bypass graft. There were no post-operative complications and the etiology of this patient’s aneurysm was determined to be a congenital ectatic dilation of his right coronary artery. The patient is doing well at 2 years of clinical follow-up.
Highlights
Giant coronary artery aneurysm’s are a very rare and lifethreatening cardiovascular condition
Initial imaging with chest X-ray (Figure 1) was performed and a contrast enhanced computed tomography (CT) scan of the chest revealed a low attenuation mass located along the right heart anteriorly that measured approximately 10 cm by 10 cm with no significant enhancement (Figure 2). At this point we considered a differential diagnosis of a pericardial cyst versus a true aneurysm or pseudoaneurysm of the right coronary artery (RCA)
Coronary artery aneurysm’s (CAA) are localized dilations of the artery that exceed the diameter by 1.5 times the largest adjacent normal vessel or a 50% increase in the arterial diameter compared with an adjacent arterial segment [1]
Summary
Giant coronary artery aneurysm’s are a very rare and lifethreatening cardiovascular condition. The presentation of a giant coronary artery aneurysm can resemble an acute coronary syndrome with thrombosis of the aneurysmal sac and subsequent ischemic symptoms from compromised blood flow. Other serious complications such as rupture of the sac and direct compressive effects within the thoracic cavity can cause serious morbidity and even be fatal for some patients.
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