PMC8842348_01
Coronary CTA with multiplanar reformatted images of the left anterior descending artery (LAD) and the diagonal branch. The LAD is a large vessel which is free of significant stenosis (Yellow arrow). There is 1 diagonal branch which has small caliber (<1 mm). The origin of this diagonal branch is patent with no plaques (red arrow). This vessel terminates abruptly raising the possibility of a small mid to distal occluded segment (green arrow).
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PMC8842348_01_10.1177_11795468211006698-fig1.jpg
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His initial electrocardiogram showed sinus rhythm with left axis deviation and Q waves in leads V1 to V2 (Supplemental Figure 1). Tomography (CT) with contrast which confirmed the presence of mild coronary artery disease with calcified and non-calcified atherosclerotic plaque in the left anterior descending artery (LAD) and possible distal occlusion of a small diagonal branch (Figure 1) with focal aneurysms in the apical lateral and mid septal wall. Cardiac Magnetic Resonance (CMR) was done to further delineate the etiology of these aneurysms and showed 2 discrete areas of ventricular wall thinning corresponding to the regions identified on CT, in addition to delayed enhancement in keeping with scar formation (Figures 2 and 3). The patient was discharged uneventfully on dual anti-platelet therapy for 1 year.
(A) Enhanced cardiac CT sagittal view shows focal aneurysm in the mid septal segment of the left ventricle (arrow) with associated minimal fatty infiltration and (B) cardiac MR short axis view confirms the presence of focal aneurysm as demonstrated on the cardiac CT.
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PMC8842348_01_10.1177_11795468211006698-fig2.jpg
fig2-11795468211006698
Tomography (CT) with contrast which confirmed the presence of mild coronary artery disease with calcified and non-calcified atherosclerotic plaque in the left anterior descending artery (LAD) and possible distal occlusion of a small diagonal branch (Figure 1) with focal aneurysms in the apical lateral and mid septal wall. Cardiac Magnetic Resonance (CMR) was done to further delineate the etiology of these aneurysms and showed 2 discrete areas of ventricular wall thinning corresponding to the regions identified on CT, in addition to delayed enhancement in keeping with scar formation (Figures 2 and 3). The patient was discharged uneventfully on dual anti-platelet therapy for 1 year.
(A) Enhanced cardiac CT axial view shows almost similar but smaller focal aneurysm in the lateral apical segment, (B, C) cardiac MR 4-chamber and short axis views confirm the presence of aneurysm (arrow), and (D) cardiac MR delayed enhancement phase shows abnormal subendocardial enhancement along the same area in the lateral apical segment.
10.1177_11795468211006698-fig3.jpg
PMC8842348_01_10.1177_11795468211006698-fig3.jpg
fig3-11795468211006698
Tomography (CT) with contrast which confirmed the presence of mild coronary artery disease with calcified and non-calcified atherosclerotic plaque in the left anterior descending artery (LAD) and possible distal occlusion of a small diagonal branch (Figure 1) with focal aneurysms in the apical lateral and mid septal wall. Cardiac Magnetic Resonance (CMR) was done to further delineate the etiology of these aneurysms and showed 2 discrete areas of ventricular wall thinning corresponding to the regions identified on CT, in addition to delayed enhancement in keeping with scar formation (Figures 2 and 3). The patient was discharged uneventfully on dual anti-platelet therapy for 1 year.