Spectrum of Coronary Artery Aneurysms: From the Radiologic Pathology Archives
Jean Jeudy1, Charles S White1, Seth J Kligerman1
1From the Department of Diagnostic Radiology and Nuclear Medicine (J.J., C.S.W., R.H., A.A.F.) and Department of Pathology (A.P.B.), University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, University of California San Diego School of Medicine, San Diego, Calif (S.J.K.); Department of Radiology, Yale University School of Medicine, New Haven, Conn (J.L.K.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (J.W.S.); Department of Radiology, North Shore University Hospital, Manhasset, NY (A.B.S.); and American Institute for Radiologic Pathology, American College of Radiology, Silver Spring, Md (A.A.F.).
Insights
Coronary artery aneurysms (CAAs) have diverse causes, including atherosclerosis and Kawasaki disease, presenting varied symptoms and complications. Diagnosis involves multiple imaging techniques, with management tailored to individual patient needs.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Coronary artery aneurysms (CAAs) are increasingly recognized, with diverse etiologies and clinical presentations.
- Pathological classification includes atherosclerotic, inflammatory, and noninflammatory groups, often with overlapping features.
- Atherosclerosis is a primary cause in adults, while Kawasaki disease is predominant in children, frequently leading to multiple CAAs.
Purpose of the Study:
- To provide a comprehensive overview of coronary artery aneurysms.
- To discuss the classification, causes, and clinical manifestations of CAAs.
- To outline diagnostic imaging modalities and management strategies for CAAs.
Main Methods:
- Review of existing medical literature on coronary artery aneurysms.
- Analysis of pathological classifications and etiological factors.
- Summary of current diagnostic and therapeutic approaches.
Main Results:
- CAAs can arise from various clinical scenarios, exhibiting variable symptoms and imaging findings.
- Common causes include atherosclerosis (adults) and Kawasaki disease (children), often resulting in multiple aneurysms.
- Potential complications encompass thrombosis, rupture, myocardial infarction, and cardiac tamponade.
Conclusions:
- Coronary artery aneurysms require a multi-faceted diagnostic approach utilizing various imaging modalities.
- Management strategies are individualized, ranging from surveillance to interventional procedures and surgery.
- Understanding the diverse causes and potential complications is crucial for effective patient care.
Abstract:
Advances in medical diagnosis reveal that coronary artery aneurysms (CAAs) may develop in several clinical scenarios and manifest variable symptoms, imaging appearances, and outcomes. Aneurysms are pathologically classified into three groups: atherosclerotic, inflammatory, and noninflammatory. The last category is associated with congenital, inherited, and connective tissue disorders. Overlap exists among the groups, because secondary atherosclerotic change may be present in an aneurysm of any cause. Atherosclerosis is the most common cause of CAAs in adults, and inflammation is considered the underlying mechanism. In children, Kawasaki disease is the most likely cause of CAAs. In both conditions, the aneurysms are usually multiple and affect more than one coronary artery. Mycotic (infectious), iatrogenic, and cocaine-induced CAAs are also well documented. Most CAAs are discovered incidentally, but potential cardiovascular complications include thrombosis, occlusion, fistula formation, rupture, myocardial infarction, and cardiac tamponade. Imaging modalities to evaluate a suspected CAA include transthoracic echocardiography, angiographic cardiac catheterization, electrocardiographically gated computed tomographic angiography, cardiac magnetic resonance (MR) imaging, and MR angiography. Management is usually individualized, and options include surveillance, anticoagulant therapy, percutaneous stent or coil placement, surgical resection, and coronary artery bypass grafting.
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