A giant isolated right coronary aneurism
Chiara Andreoli1, Emilia Biscottini1, Johny Helou1
1Department of Cardiology, S.G.Battista Hospital, Foligno (PG), Italy.
BJR Case Reports
|January 20, 2022
Summary
Tuberculosis can manifest with gastrointestinal symptoms and cardiac complications. This case highlights a rare presentation of tuberculosis causing cecal lesions and a giant coronary artery aneurysm.
Area of Science:
- Cardiology
- Gastroenterology
- Infectious Diseases
Background:
- Tuberculosis (TB) typically affects the lungs but can present with extrapulmonary manifestations.
- Gastrointestinal TB can mimic inflammatory bowel disease, presenting with symptoms like rectorrhagia.
- Cardiac involvement in TB is rare, particularly coronary artery aneurysms.
Observation:
- A 32-year-old female presented with rectorrhagia and was found to have caseating granulomas in the cecum.
- A positive purified protein derivative (PPD) skin test suggested TB infection.
- Unexpectedly, a CT scan revealed a large cardiac mass, later identified as a giant aneurysm of the proximal right coronary artery.
Findings:
- Histopathology confirmed caseating granulomas in the cecum, consistent with tuberculosis.
- The cardiac mass was diagnosed as a giant (5 x 4.8 cm) isolated aneurysm of the proximal right coronary artery with significant thrombosis.
- Anti-TB treatment led to complete resolution of the cecal lesions.
Implications:
- This case underscores the diverse clinical presentations of tuberculosis, including rare gastrointestinal and cardiac involvement.
- Early diagnosis and comprehensive treatment are crucial for managing complex TB cases with multi-organ involvement.
- The successful management involved a multidisciplinary approach combining anti-TB therapy, anticoagulation, and surgical intervention for the coronary aneurysm.
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