Presentation
Chest pain, gradually increasing shortness of breath on exertion.
Patient Data
Coronary arteries:
Right dominant coronary system.
LMS: Normal.
LAD: Moderate to severe calcified plaque in the proximal vessel, 50-70% stenosis. Moderate to severe mixed plaque in the mid vessel, 50-70% stenosis. Moderate mixed plaque in D1, 50-70% stenosis.
LCX: Moderate to severe mixed plaque in the proximal circumflex and OM2, 50-70% stenosis. Mild calcified plaque in the OM1, less than 50% stenosis.
RCA: Mild calcified plaque in the proximal vessel, less than 25% stenosis. Moderate severe mixed plaque in the mid vessel, 50-70% stenosis. In the distal vessel, there is a partially thrombosed coronary aneurysm (~13 mm outer diameter), with relatively normal lumen and some mild mixed plaque, less than 25% stenosis.
Cardiac findings:
Normal cardiac valves and chambers.
Non-cardiac findings:
Moderate mixed centrilobular and paraseptal emphysema. Allowing for the phase of respiration the partially imaged lung parenchyma is otherwise unremarkable. No enlarged mediastinal or axillary lymph nodes. Hiatus hernia. Fatty liver. Otherwise unremarkable upper abdominal viscera. No significant bony abnormalities.
Conclusion:
Non-obstructive coronary artery disease. Large partially thrombosed aneurysm within the distal RCA.
Case Discussion
Coronary artery aneurysms are a rare but important finding to identify in patients having cardiac imaging. Coronary artery aneurysms result from the localized dilation or bulging of the artery walls and can be caused by various factors, including atherosclerosis, connective tissue disorders, infections, or congenital abnormalities. Kawasaki syndrome is an important cause in the pediatric population.
Complications of coronary artery aneurysms include thrombosis formation, embolism, or rupture, which can lead to myocardial infarction or other life-threatening complications.
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