Giant Pseudoaneurysm Caused by Ruptured Coronary Artery Aneurysm Presenting as a Right Paracardial Mass.

Abstract

HomeCirculation: Cardiovascular ImagingVol. 12, No. 4Giant Pseudoaneurysm Caused by Ruptured Coronary Artery Aneurysm Presenting as a Right Paracardial Mass Free AccessCase ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessCase ReportPDF/EPUBGiant Pseudoaneurysm Caused by Ruptured Coronary Artery Aneurysm Presenting as a Right Paracardial MassDiagnosis Using Multimodality Imaging Kai Yang, MD and Shi-hua Zhao, MD, PhD Kai YangKai Yang Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China. Search for more papers by this author and Shi-hua ZhaoShi-hua Zhao Shi-hua Zhao, MD, PhD, Department of Magnetic Resonance Imaging, No. 167, Beilishi Road, Xicheng District, Fuwai Hospital, Beijing 100037, China. Email E-mail Address: [email protected] Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China. Search for more papers by this author Originally published3 Apr 2019https://doi.org/10.1161/CIRCIMAGING.118.008788Circulation: Cardiovascular Imaging. 2019;12:e008788A 28-year-old man admitted to our hospital due to paroxysmal palpitations and dizziness for over 1 year. On admission, he did not feel any obvious discomfort. Physical examination and ECG were normal. Chest X-ray showed barely visible eggshell calcification in the cardiac silhouette (Figure [A and B]). Echocardiography revealed a 7×4 cm mass adjacent to the right heart in the pericardium. Then cardiac magnetic resonance imaging was recommended to detect the mass. Cardiac magnetic resonance demonstrated a 7.0×4.5×6.5 cm mass in the right atrioventricular groove, which compressed the right atrium, tricuspid annulus, and right ventricular inflow tract. First pass perfusion and late gadolinium enhancement imaging showed early filling and obvious enhancement in the center of the mass (Figure [C through E]; Data Supplement). Based on above information, the mass was likely to be a hemangioma. Further investigations, including coronary angiography and computed tomography angiography, were made to confirm the diagnosis. Coronary angiography and computed tomography angiography clearly showed a pseudoaneurysm caused by a ruptured aneurysm (1.5×1.4 cm) in the proximal segment of right coronary artery, with massive mural thrombus and eggshell calcification at the edge (Figure [F through I]; Data Supplement). After the diagnosis was confirmed, the patient was transferred to the surgical department and accepted a surgical repair. In conclusion, as for cardiac space-occupying lesions in the atrioventricular or interventricular groove, coronary artery aneurysm, or pseudoaneurysm should be taken into consideration, especially when the aneurysm was filled with mural thrombus, which can create a diagnostic challenge masquerading as a cardiac mass. Comprehensive application of multimodality imaging can provide an accurate diagnosis of this kind of tumor-like lesions.Download figureDownload PowerPointFigure. Final diagnosis confirmed by multimodality imaging. A and B: Chest X-ray showed barely visible eggshell calcification in the cardiac silhouette. C–E: Cardiac magnetic resonance demonstrated a right paracardial mass (7.0×4.5×6.5 cm), compressing the right heart chambers, first pass perfusion and late gadolinium enhancement imaging showed early filling and obvious enhancement in the center of the mass (yellow arrow: right paracardial mass; black asterisk: enhancement region; white asterisk: no enhancement region). F–H: Computed tomography angiography revealed a giant pseudoaneurysm caused by a ruptured aneurysm (1.5×1.4 cm) in the proximal segment of right coronary artery, with massive mural thrombus and eggshell calcification at the edge (black asterisk: blood pool; white asterisk: mural thrombus). I: Coronary angiography showed the same results to computed tomography angiography (yellow arrow: pseudoaneurysm and eggshell calcification; white arrow: coronary aneurysm; red arrow: the site of rupture).DisclosuresNone.FootnotesThe Data Supplement is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCIMAGING.118.008788.Shi-hua Zhao, MD, PhD, Department of Magnetic Resonance Imaging, No. 167, Beilishi Road, Xicheng District, Fuwai Hospital, Beijing 100037, China. Email [email protected]com Previous Back to top Next FiguresReferencesRelatedDetails April 2019Vol 12, Issue 4 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/CIRCIMAGING.118.008788PMID: 30939919 Originally publishedApril 3, 2019 Keywordscoronary aneurysmechocardiographyphysical examinationdizzinessperfusionPDF download Advertisement SubjectsDiagnostic TestingImaging