Giant Right Coronary Artery Aneurysm Incidentally Found During Stroke Evaluation Through Echocardiography
Jessica M Gonzalez1, Gabriel Lowenhaar2, Prasad Chalasani3
1Internal Medicine, Brown University, Providence, USA.
Insights
Giant coronary artery aneurysms (CAAs) are rare. This case highlights echocardiography as a potential diagnostic tool for identifying CAAs, which are often found via cardiac catheterization.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Giant coronary artery aneurysms (CAAs) are uncommon manifestations of coronary artery disease.
- Diagnosis typically relies on cardiac catheterization.
Observation:
- An 82-year-old male presented with stroke symptoms.
- Initial echocardiography suggested a right atrial cyst, but further imaging was needed.
- Cardiac catheterization revealed extensive CAAs, including LAD occlusion and a large right coronary artery aneurysm.
Findings:
- Echocardiography, including transesophageal echocardiography, visualized a mass near the tricuspid annulus.
- Cardiac catheterization confirmed multiple CAAs with significant occlusive disease.
- The echocardiographic finding was a misinterpretation of the CAA.
Implications:
- Echocardiography may serve as an initial screening tool for coronary artery aneurysms.
- This case underscores the importance of comprehensive cardiovascular evaluation in stroke patients.
- Improved diagnostic capabilities for CAAs can lead to earlier intervention and better patient outcomes.
Abstract:
Giant coronary artery aneurysms (CAAs) are rare forms of coronary artery disease. An 82-year-old man presented to the hospital with generalized weakness, arm numbness, and dizziness and was found to have a multi-infarct stroke. A transthoracic echocardiogram was obtained to determine a possible cardiovascular etiology of his stroke. However, it did not reveal thrombi or vegetation; instead, it showed a ring-like structure adjacent to the tricuspid valve that appeared to be a large right atrial cyst. A transesophageal echocardiogram was performed localizing the ring-like mass near the tricuspid annulus. Cardiac catheterization revealed aneurysms of the coronary arteries with complete distal occlusion of the left anterior descending artery (LAD), an aneurysmal left circumflex, and a right coronary artery with a very large aneurysm without signs of thrombus or flow-limiting lesion. CAAs are usually found through cardiac catheterization. Echocardiography may be a novel way of identifying CAAs.
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