Thrombosed right coronary artery aneurysm presenting as a myocardial mass

Area of Science:

• Cardiology
• Vascular Medicine
• Diagnostic Imaging

Background:

• Coronary artery aneurysms (CAAs) are rare vascular abnormalities, defined by significant dilatation of coronary arteries, occurring in 1.5% to 5% of the population.
• Pathologically, CAAs result from medial destruction and arterial wall thinning, leading to increased wall stress and progressive dilatation, commonly associated with atherosclerotic coronary artery disease.

Observation:

• A 60-year-old male with hypertension presented with symptoms of an inferior wall myocardial infarction.
• Transthoracic echocardiography initially identified an intramyocardial mass, prompting further investigation.
• The observed mass was subsequently diagnosed as a thrombosed right coronary artery aneurysm.

Findings:

• The case illustrates a thrombosed coronary artery aneurysm mimicking an intramyocardial mass.
• Atherosclerotic coronary artery disease is the primary etiology for most coronary artery aneurysms.
• While rupture is possible, thrombosis and hematoma formation are more common complications, leading to diagnostic challenges.

Implications:

• Accurate diagnosis of coronary artery aneurysms is crucial, especially when they present as intramyocardial masses.
• Echocardiography can be an initial tool, but advanced imaging may be necessary for definitive diagnosis.
• Understanding the potential for coronary artery aneurysms to mimic other cardiac pathologies is vital for appropriate patient management.