PMC7193272_01
Short axis view (SAX) of transthoracic echocardiography (TTE) in our patient shows ectasia at left anterior descending (LAD) artery and huge aneurysm with large circular nonorganized thrombosis occupying the majority of the aneurysm, narrowing the internal lumen of the artery.
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fig1
Transthoracic echocardiography was performed showing diffuse ectasia and dilation with huge aneurysm in the left anterior descending artery (LAD) with the size of 14 mm (Figure 1).
Saddle nose in our patient with granulomatosis with polyangiitis.
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Finally, based on the history of severe upper airway infection, pulmonary cavitary lesion, saddle nose (Figure 2), elevated ESR and CRP, positive ANA and ANCA with perinuclear pattern (P-ANCA), granulomatosis with polyangiitis (Wegener granulomatosis) was diagnosed for this patient.
(a) High-resolution, ECG-synchronized computed tomography of the heart with attention to the coronary arteries showed left main coronary ectasia (4.2 mm), fusiform aneurysmal dilation measured 19 mm length, and14 mm transverse diameter with partial thrombosis in the lumen measured 17 x 10 mm in proximal segment of left anterior descending artery (LAD) and aneurysmal dilatation in proximalpart of left circumflex (LCX) in 5 mm diameter. (b) A cavity formation in the left lung apex measure 36 x 27 x 21 mm and some fibrotic and atelectatic bands in bases of both lung.
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fig3
On a follow-up, transthoracic and transesophageal echocardiographic evaluation, large circular nonorganized thrombosis occupying the majority of the aneurysm was noted that was confirmed by CT angiography despite the anticoagulation prophylaxis (Figure 3).