Giant coronary artery aneurysm masquerading as an anterior mediastinal mass
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CASE REPORT
Giant coronary artery aneurysm masquerading as an anterior mediastinal mass Rachel Deitz1 · Olugbenga Okusanya2 · Arman Kilic3 · Leonid Emerel1 · Ibrahim Sultan3,4 Received: 14 June 2020 / Accepted: 25 August 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Coronary artery aneurysms are exceedingly rare and tend to be found incidentally on angiography. We present the case of a 6 cm giant coronary artery aneurysm discovered in a 25 year old man. Subsequent workup included cardiac-gated MRI, CT angiography, and left heart catheterization. Imaging revealed a 6.7 × 6.2 × 6.0 cm aneurysm involving the mid LAD subsequent to the takeoff of a large septal perforator. The patient was taken electively for operative repair during which the aneurysm was opened, unroofed, and ligated at the ostium while taking care to ensuring normal flow in the septal perforator that supplied multiple small collaterals. In this unique case, a coronary artery aneurysm of considerable size was encountered in the LAD of a healthy young adult in which the size of the aneurysm precluded distal revascularization via bypass grafting. Multiple imaging modalities were used to characterize this finding and aid in surgical planning. Keywords Coronary artery aneurysm · Cardiac imaging · Surgical repair
Introduction Giant coronary artery aneurysms (CAA) are a rare entity with a reported incidence of around 0.02%. They are typically discovered incidentally on angiography. Though they have no singular accepted definition, they tend to be understood as coronary aneurysms greater than 20 mm and occur most often in the right coronary artery (RCA). Up to 50% of cases are attributed to atherosclerosis, followed by congenital causes (17–30%), and sequelae of Kawasaki disease (10%) with other rare etiologies including vasculitides and
* Rachel Deitz [email protected] 1
Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, 200 Lothrop Street, Ste C800, Pittsburgh, PA 15213, USA
2
Division of Thoracic Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
3
Division of Cardiac Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
4
Heart and Vascular Institute, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
connective tissue disorders [1]. Due to the rare and heterogeneous presentation of coronary artery aneurysm, there are no uniform guidelines with respect to medical or interventional management [2]. In this report, we present a case of an incidentally found giant left anterior descending artery (LAD) aneurysm in a young healthy male, the imaging modalities used for diagnosis and operative planning, and the surgical approach utilized.
Case description A 25 year old man presented to the emergency department with chest pain and was found to have a spontaneous pneumothorax on chest X-ray. His past medical history was significant for prior bi
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