CASE PRESENTATION
A 67-year-old woman was referred to our hospital due to an incidental finding of a cardiac mass on a chest-computed tomography (CT), during an investigation of sudden dyspnea. She had normal sinus rhythm, with no ST-segment changes on electrocardiography. Transthoracic echocardiography revealed a 6.3x5.9 cm anechoic mass, partially compressing the right chambers; cardiac function was normal, and no ventricular akinesia was found. Coronary angiotomography showed a saccular aneurysmal dilatation in the middle segment of the right coronary artery (RCA), with 5.7x5.7 cm associated with a calcified mural thrombus (Figure 1), without significant coronary stenosis. Investigation with whole-body CT scan and cerebral magnetic resonance imaging excluded other vessel aneurysms.
The patient underwent surgery through full sternotomy, with resection of a giant RCA aneurysm and exclusion of both entrance and exit ostia (Figure 2). Coronary artery bypass was performed with a saphenous vein graft to the RCA. Histologic study was suggestive of arteritis sequela represented by diffuse thickening of intimal and medial layers with fibrosis, and destruction of the elastic lamina (Figure 3).
Patients with giant coronary artery aneurysms are at high risk of complications and must benefit from aneurysm exclusion1. This is a rare condition and atherosclerosis accounts for half of the cases in adults; however, it may also be part of a systemic inflammatory disease2, as presented in this case.