Giant right coronary aneurysm: a coronary CT angiography exhibited severe aneurysmatic dilation of the right coronary ar
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Giant right coronary aneurysm: a coronary CT angiography exhibited severe aneurysmatic dilation of the right coronary artery Pedro von Hafe1 · Geraldo Dias1 · Filipa Cardoso1 · Margarida Oliveira1 · Ricardo Ladeiras Lopes2,3 · Sérgio Leite1 Received: 12 October 2020 / Accepted: 15 October 2020 © Springer Nature B.V. 2020
Introduction
Clinical case
Coronary artery aneurysms are rare, with an incidence of 0.15% to 4.9% on angiography. Giant coronary artery aneurysms (GCAA) are even rarer, with an incidence of 0.02% this subtype measure > 2 cm in diameter. In some literature, a coronary artery aneurysm is labeled as “giant” if its size exceeds 5 cm. Coronary aneurysms are more common in men. In most cases, only single coronary artery aneurysms have been reported [1].
A 71-year-old woman was referred to a cardiology consultation for dyspnea. The patient reported that, 11 years earlier, she had undergone a catheterization and an intervention that she was unable to specify. An echocardiogram showed blood flow between enlarged coronary sinus and a giant echolucent structure compressing de right atrium. A coronary CT angiography exhibited severe aneurysmatic dilation of the right coronary artery (A, white arrow), with a maximum diameter of 6 cm in its distal region and with preserved ostial origin and caliber (B, red circle). This exam also shows the dilation of the coronary sinus with a maximum diameter of 41 mm (B, red arrow).
* Pedro von Hafe [email protected] 1
Senhora da Oliveira Hospital, Creixomil, Portugal
2
Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal
3
Universidade do Porto, Porto, Portugal
13
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The International Journal of Cardiovascular Imaging
Panel A shows coronary dilation on CT using the volume rendering technique. Panel B shows a CT image exhibit the origin of the right coronary. Panels C and D show, respectively, the diagnosis and treatment on angiography images
Finally, angiography images were accessed that showed the closure of a fistula between GCAA (C, white arrow) and coronary sinus, that was closed with several metallic structures—coil embolization (D, red arrow).
Conclusion GCAA are usually referred for surgical treatment. In this case a percutaneous approach for closure of a giant fistula was successful.
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There is no established treatment for coronary artery aneurysms with medical and surgical options available. The 5-year survival of coronary artery aneurysms is ~ 70% [2]. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
The International Journal of Cardiovascular Imaging
Compliance with ethical standards Conflict of interest The authors declared that they have no conflict of interest.
2. Díaz-Zamudio M, Bacilio-Pérez U, Herrera-Zarza MC et al (2009) Coronary artery aneurysms and ectasia: role of coronary CT angiography. Radiographics 29(7):1939–1954 Publisher’s Note Springer Nature remains neutral with regar
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