Tiny ruptured coronary aneurysm with coronary-pulmonary arterial fistula

Area of Science:

• Cardiology
• Vascular Surgery
• Medical Imaging

Background:

• Spontaneous coronary artery aneurysm (CAA) rupture is a rare but serious cardiovascular event.
• Coronary artery fistulas, particularly coronary pulmonary arterial fistulas (CPAF), can complicate CAA rupture.
• Ruptured CAAs with CPAF are infrequently reported, with most cases involving larger aneurysms and older female patients.

Observation:

• A 44-year-old man presented with chest pain.
• Enhanced computed tomography and angiography revealed a 1.5 cm spontaneous ruptured coronary aneurysm with a coronary pulmonary arterial fistula (CPAF).
• The patient had pericardial effusion collection secondary to the rupture.

Findings:

• Surgical resection of the ruptured coronary aneurysm was performed.
• The associated coronary pulmonary arterial fistula (CPAF) was successfully and safely closed.
• Complete resolution of the aneurysm and fistula was achieved.

Implications:

• This case highlights that even small coronary aneurysms can rupture and present with CPAF.
• It expands the clinical spectrum of ruptured coronary aneurysms, including presentation in middle-aged men.
• Successful surgical management demonstrates the viability of intervention for these rare conditions.