Isolated Partially Thrombosed Aneurysm of the Left Main Coronary Artery in an Asymptomatic 60-Year- Old Cyclist

Abstract

A 60-year-old asymptomatic male cyclist was referred for a screening computed coronary artery calcium scoring (CAC) prior to a week-long bike ride. He denied any chest pain or dyspnoea, and had no relevant personal medical or family history. He was a non–smoker. His CAC was 2,745 (99th percentile for age and sex). In view of the high CAC, we proceeded to perform a computed tomographic coronary angiography (CTCA), which demonstrated a giant calcific aneurysm of the distal left main coronary artery, measuring 18.5 × 15 × 18 mm partially filled with thrombus. The rest of the arteries were widely patent and showed no atherosclerosis. Extended vasculitis screen was negative and other causes of coronary aneurysm such as coronary trauma, percutaneous coronary angioplasty, Takayasu diseases, syphilis, Behçet disease, and neurofibromatosis were excluded. Kawasaki disease was proposed as the most probable cause. Cardiac magnetic resonance imaging demonstrated normal left ventricular size and systolic function and absence of scar. Adenosine perfusion magnetic resonance imaging showed no ischaemia. After a detailed discussion, the patient decided to carry on with his plans regarding the ride albeit with a reduction in effort given likely longevity and stability of the clinical condition. The optimal therapy for patients with isolated coronary artery aneurysm is not established with uncertainty about benefits of interventional/surgical treatment. Aneurysms of the left main coronary artery are rare clinical entities, encountered incidentally in approximately 0.1–0.3% of patients undergoing routine angiography. Kawasaki disease and atherosclerotic coronary artery disease are the common aetiologies.