Use of cardiac computed tomography in the management of symptomatic coronary aneurysm: A case study and literature review

Abstract

Coronary artery aneurysms are rare malformations caused by atherosclerosis, connective tissue disease or vasculitides, and are usually discovered incidentally with invasive coronary angiography. A case involving a 58-year-old male presenting with an acute coronary syndrome who was found on invasive angiogram to have a giant aneurysm of the left anterior descending coronary artery is described. The incidence, pathophysiology and management of giant aneurysms in the context of an acute coronary syndrome are reviewed.

Keywords: Aneurysm; Bypass graft; CT angiography; Left anterior descending; Thrombosis.

Figure 1)

Preoperative right anterior oblique angiogram of the left main artery (LM). Note the double density involving the ostial left anterior descending artery (LAD) (arrowhead) representing a clot-filled aneurysm as well as a filling defect of the ostial septal perforator (Sp) showing embolization of the clot (thin black arrow). Cx Circumflex

Figure 2)

A Preoperative 64-slice cardiac computed tomography multiplanar reformat image showing a large aneurysm measuring 3.0 cm × 1.8 cm × 1.6 cm. A filling defect is shown in the aneurysmal segment of the left anterior descending artery (LAD) (large arrow) as well as a filling defect in the septal perforator (Sp) (small arrow). B Three-dimensional computed tomography reconstruction showing a large left coronary artery aneurysm of the LAD. RCA Right coronary artery

Figure 3)

A Intraoperative photograph of the left coronary artery aneurysm. The circumflex (Cx) and left anterior descending artery (LAD) segments are visualized, along with the aneurysmal component (arrow). B Intraoperative photograph showing the resected aneurysm (arrow) and clot (arrowhead) removed from ostial LAD. Note the fingerlike projections that have formed a cast of the first septal perforator (thin arrow)