Coronary Venous Aneurysm in Patients Without Cardiac Arrhythmia as Detected by MDCT: An Anatomic Variant or a Pathologic Entity

Abstract

The aim of this study was to determine the prevalence of coronary venous aneurysm in patients with no history of cardiac arrhythmia using 64-slice multidetector computed tomography. Coronary vein aneurysm frequently has been reported in association with cardiac arrhythmias such as ventricular pre-excitation. Coronary computed tomography angiograms of 187 patients (108 men, 79 women; mean age +/- SD, 60 +/- 12 years) were analyzed retrospectively for the presence of a focal coronary venous aneurysm. Fusiform aneurysm was defined as a focal dilatation of twice the normal vein. However, any size of diverticular aneurysms was included. Cross-sectional diameters of normal and aneurysmal segments of the posterior interventricular vein, great cardiac vein, and coronary sinus (CS) were measured at mid-diastole, late systole, and atrial systole. The Student t test was used for continuous variables and contingency tables were used for categorical variables. A single aneurysm was found in 19 (10%) patients (fusiform, n =16; diverticular, n = 3). The most common anatomic location was the posterior interventricular vein near the confluence with the CS (n = 14), followed by the great cardiac vein near the junction with the CS (n = 3), and the CS (n = 2). The mean diameter of the aneurysms was 9.3 +/- 1.2 mm (range, 8.1 to 11.4 mm) at mid-diastole and 10.4 +/- 1.4 mm (range, 8.5 to 12.7 mm) at late systole. However, the difference was not statistically significant. All normal CSs and 1 aneurysm arising from the CS showed contraction during atrial systole, which may suggest atrial myocardial coverage of these structures. Patients with a venous aneurysm were significantly older than patients without an aneurysm (67.6 +/- 11 vs. 59 +/- 12 years, respectively; p = 0.006). Coronary vein aneurysms (especially the fusiform type) were seen in up to 10% of patients with no history of cardiac arrhythmia and can be well visualized on computed tomography angiograms.