A giant isolated right coronary aneurism

Abstract

A previously healthy 32-year-old female hailing from Mexico presented to the emergency department with rectorrhagia. Caseating granulomas were detected on histopathological analysis from cecum ulcerative lesions. A purified protein derivative skin test resulted positive. In order to exclude pulmonary tubercolosis, a CT lung scan was performed: a rounded and voluminous mass, located above the right atrioventricular cardiac junction, was unexpectedly revealed. Further, a cardiac magnetic resonance and a coronary angiography disclosed a giant (5 × 4,8 cm) isolated aneurysm of proximal right coronary artery with severe thrombotic layering. The patient was treated with isoniazid, rifampin, ethambutol, and pyrazinamide; after approximately 2 months of treatment, she had complete resolution of cecal lesions. Anticoagulant oral therapy with warfarin was started and the patient was submitted to coronary artery grafting bypass surgery.

Figure 1.

CT lung scan: isodence mass with no calcifications determining bulge on the right antero lateral cardiac border.

Figure 2.

CMR four chamber: rounded ipointense mass with clear borders, central hyperintensity and concentric trombotic layering. CMR, cardiac magnetic resonance.

Figure 3.

CT scan 2 MIP 3D: hypervascular mass of right coronary artery. 3D, three-dimensional; MIP, maximum intensity projection..

Figure 4.

Coronary angiography: proximal right coronary artery aneurism with dilatation at the mid-tract, a 70% stenosis at the crux and TIMI three flow.