PMC8212995_01
(A,C) Contrast-enhanced computed tomography images 4 years ago (A) and on admission (C). (B,D) 3D coronary angiography 4 years ago (B) and on admission (D). (E,F) Histological findings of surgically resected tissue of the sinus of Valsalva. Images of Elastica von Gieson staining [(E); original magnification 100x] and hematoxylin and eosin staining [(F); original magnification 400x; scale bar, 100 mm] are shown. A, adventitia; M, media; I, intima. Arrows indicate the site with disruption of elastic fibers in the medial layer. Arrow heads indicate giant cells.
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F1
Dilatation of the sinus of Valsalva together with protrusion of the right sinus of Valsalva, which had not been observed 4 years ago, were found by computed tomography (CT, Figures 1A-D). In addition, the CT images revealed severe ostial stenosis of the left coronary artery and mild ostial stenosis of the right coronary artery (Figures 1A-D). In histological analyses of the resected sinus of Valsalva, massive infiltration of lymphocytes, histiocytes, and giant cells mainly in the media and adventitia with destruction of the media was found (Figures 1E,F).
(A,D) Images of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography before (A) and after (D) steroid therapy. Arrows indicate the anastomotic site with left coronary artery aneurysm. (B,C,E,F) 3D coronary angiography and contrast-enhanced CT images before (B,C) and after steroid administration (E,F).
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F2
Approximately 3 months later, a follow-up study revealed a left coronary ostial aneurysm at the anastomotic site together with strong 18F-FDG uptake (Figures 2A-C), which was not detectable by transthoracic echocardiography. Disappearance of strong 18F-FDG uptake was found a month after the commencement of steroid therapy (Figure 2D). CT scan showed disappearance of the left coronary ostial pseudoaneurysm (Figures 2E,F). Clinical courses of this case were summarized in Figure 3.
Clinical courses of this case.
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F3
CT scan showed disappearance of the left coronary ostial pseudoaneurysm (Figures 2E,F). Clinical courses of this case were summarized in Figure 3.