Coronary artery pseudoaneurysm

Case contributed by Harikrishnan Nandakumar
Diagnosis certain

Presentation

Chest pain and new onset atrial flutter.

Patient Data

Age: 80 years
Gender: Male

CT angiography of the thorax demonstrates a focal discontinuity of the proximal right coronary artery stent. There is an adjacent contrast-filled outpouching arising from the RCA within the right atrioventricular groove measuring 3.1 x 3.0 cm. The vascular lesion demonstrates a narrow collar, compatible with a pseudoaneurysm.

Additional findings of large-volume hyperattenuating pericardial effusion compatible with hemopericardium.

Case Discussion

The patient subsequently underwent surgical repair of the right coronary artery (RCA) pseudoaneurysm along with a coronary artery bypass graft with right internal mammary artery anastomosis to the RCA. Additional complete decortication and removal of organized hemopericardium.

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