PMC5577072_01
Chest X-ray film (A), electrocardiogram (B) and echocardiogram (C-E) of the patient early during admission at our hospital. An echocardiogram showed an enlarged mass lesion measuring nearly 80 mm (white arrow).
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Chest X-ray film showed an expanded heart shadow and pulmonary congestion (Fig. 1A). An electrocardiogram showed ST elevation in leads II, III and aVF (Fig. 1B). An ultrasonic echocardiogram showed a decreased left ventricular ejection fraction (25% calculated by the modified Simpson method), moderate mitral regulation and an enlarged mass lesion measuring nearly 80 mm (Fig. 1C-E, white arrow).
Emergent coronary angiography showed two giant coronary artery aneurysms (CAAs; A: white and red arrows) in the RCA, severe coronary stenosis (>90%) in the left main trunk (LMT), an occluded left circumflex artery (B: white arrows) and multiple CAAs in the LMT and the proximal portion of the left anterior descending artery (B: white rectangle). Emergent computed tomography showed an 85-mm round mass in the RCA (C-E), which had ruptured into the right atrium (D: white arrow).
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Emergent coronary angiography showed two giant coronary artery aneurysms (CAAs; Fig. 2A, white and red arrows) in the right coronary artery (RCA), which was totally occluded at the distal portions of the CAAs. There was severe coronary stenosis (>90%) in the left main trunk (LMT), and the left circumflex artery was totally occluded (Fig. 2B, white arrows). CAAs were also seen in the LMT and the proximal portion of the left anterior descending artery (Fig. 2B, white rectangle). Emergent computed tomography showed an 85-mm round mass in the RCA, which had ruptured into the right atrium (Fig. 2C-E, white arrow).
Intraoperative view of giant coronary artery aneurysm (A: white rectangle). After the giant CAA was removed. we could see the fistula from the coronary artery to the right atrium (B: white arrow). The resected aneurysm was filled with giant organized thrombi and fresh red thrombi (C). We observed severe atherosclerosis in the efferent vessels of the giant CAA (D). A pathological examination revealed organized thrombi and blood cells with no blood vessel components (E).
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After median sternotomy, a giant CAA was identified (Fig. 3A, white rectangle). When the RCA aneurysm was removed, we could see a fistula entering the right atrium from the back of the CAA (Fig. 3B, white arrow). The resected aneurysm was filled with giant organized thrombi and fresh red thrombi (Fig. 3C). Severe atherosclerosis was noted in the efferent vessels of the giant CAA (Fig. 3D). A pathological examination revealed only organized thrombi and blood cells with no blood vessel components (Fig. 3E).