Giant aneurysm of circumflex coronary artery in asymptomatic patient

Abstract

IntroductionCoronary artery aneurism (CAA) is a rare condition, characterized by a dilatation of 1.5 times the diameter of an adjacent normal coronary vessel. Finding of a giant CAA is a very uncommon event. We present a case of incidental finding of an asymptomatic giant aneurism affecting the circumflex coronary artery; then we discuss epidemiology, etiology and clinical approach, referring to published literature data. Case ReportA 74-year-old woman presented at hospital with fever and uncontrolled hypertension. Over the past years, she had suffered from chronic obstructive pulmonary disease (COPD) and hypertension that had not been further investigated. While blood specimens showed no significant findings (mild inflammation), chest radiograms revealed the presence of a pulmonary mass and a transthoracic echocardiography revealed an anechogenic interatrial lesion, that measured 56 mm, with apparent internal flow (Figure 1). Chest computed tomography (CT) with radiopaque contrast showed a solid lesion in the superior left pulmonary lobe, while the cardiac angiographic multi-slice CT showed a markedly ectatic and winding circumflex artery (maximum diameter: 8 mm), with a saccular aneurysm placed between the medium and the distal third of the vessel, just after a marginal branch emergence. The aneurysm measured 6.4×5.5 cm and presented nor endoluminal thrombosis neither parietal calcifications. The distal branch of circumflex artery overflowed into the extremely dilated and winding Giant aneurysm of circumflex coronary artery in asymptomatic patient ABSTRACTWe report a case of a 74-year-old woman who presented to the hospital for fever and uncontrolled hypertension. We found, incidentally, a giant aneurysm of the circumflex coronary artery measuring 6.4×5.5 cm. We show suggestive computed tomographic scan images, multi-slice reconstructions and a review of the epidemiology, diagnosis and treatment of this condition. Contributions: AB was involved with review of the literature, diagnostic process and drafting of the manuscript; OP, CDF, GF, GB and GPV were involved with radiological and ultrasound analysis and drafting; GM, PF and CP were involved in the diagnostic process and drafting.Conflict of interest: the authors declare no conflict of interest.