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Giant right coronary artery aneurysms presenting as a cardiac mass: Case report
Huanhuan Wang1, Yin Zhang, Yanbo Xie
1Division of Cardiology Division of Cardiovascular Surgery Division of Pathology, Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China.
Insights
Giant coronary artery aneurysms (CAA) with thrombus can mimic cardiac masses. This case highlights successful surgical treatment of a large right coronary artery aneurysm presenting as a mass, emphasizing diagnostic challenges and therapeutic outcomes in managing this rare condition.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Coronary artery aneurysm (CAA) is defined as coronary dilatation exceeding 1.5 times normal diameter.
- Giant CAAs are rare, with limited reported cases, making incidence difficult to ascertain.
Observation:
- A 65-year-old asymptomatic man presented with a cardiac "mass" on echocardiography.
- Coronary angiography revealed stenosis in LAD/LCX and ectasia in RCA; CTA identified giant RCA aneurysms with thrombus.
- Histopathology of the RCA showed intimal lipid/hyalin deposits, calcifications, and a thinned/absent media.
Findings:
- Coronary computed tomography angiography (CTA) accurately diagnosed giant right coronary artery (RCA) aneurysms with thrombus.
- Surgical intervention via coronary artery bypass graft (CABG) with thrombectomy successfully treated the condition.
- Histopathological analysis revealed degenerative changes in the RCA wall.
Implications:
- Giant coronary artery aneurysms with thrombus pose diagnostic challenges, potentially complicating angiography due to embolization risk.
- Successful surgical management (CABG with thrombectomy) is feasible for large, symptomatic RCA aneurysms.
- This case underscores the importance of advanced imaging and surgical intervention for rare cardiovascular pathologies.
Introduction:
Coronary artery aneurysm (CAA) is defined as coronary dilatation which exceeds the diameter of the normal adjacent artery segments or the diameter of the patient's largest coronary artery by 1.5 times. The incidence of giant CAA is difficult to be determined, since only few reports have been described in the literature.
Methods And Results:
A 65-year-old man was referred to our hospital because of a "mass" in the right heart detected on echocardiography at a regular medical health examination, while he experienced no any symptoms. Coronary angiography showed the severe stenosis of the left anterior descending artery (LAD) and the left circumflex artery (LCX) and the diffusely ectatic change of the right coronary artery (RCA), but no mass was found in any of these arteries. Coronary computed tomography angiography (CTA) confirmed that the "mass" was the giant aneurysms of RCA with thrombus. He received coronary artery bypass graft (CABG) with thrombectomy. The histopathology showed the deposits of lipid and hyalin in the tunica intima, the focal calcifications, the very thin tunica media, and the disappearance of the part of the tunica media in the RCA.
Conclusions:
Coronary artery aneurysm which may contain thrombus can complicate a diagnostic coronary angiography due to the risk of distal embolization and may lead to myocardial infarction. This case report demonstrates 2 RCA aneurysms with a thrombus presenting as a giant "mass" which was successfully treated by CABG with thrombectomy.
