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A Rare Combination of Giant Right Coronary Artery Aneurysm.

Haider I, Suksaranjit P, Wilson B, McGann C - N Am J Med Sci (2015)

Bottom Line: CAA is commonly found in the right coronary artery with significant number of cases associated with fistula formation.We describe a rare case of an 87 year-old man with large CAA with fistulous drainage into the right ventricle (RV) along with RV free wall vegetation as a cause of chronic weakness and lethargy.Giant CAA with fistulous drainage to the RV could present in the form of infective endocarditis.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Division of Cardiology, University of Utah, Salt Lake City, Utah, United States.

ABSTRACT

Context: Giant coronary artery aneurysm (CAA) in adults is a rare clinical entity with an estimated incidence of 0.02%. CAA is commonly found in the right coronary artery with significant number of cases associated with fistula formation.

Case report: We describe a rare case of an 87 year-old man with large CAA with fistulous drainage into the right ventricle (RV) along with RV free wall vegetation as a cause of chronic weakness and lethargy.

Conclusion: Giant CAA with fistulous drainage to the RV could present in the form of infective endocarditis. Early detection and surgical treatment would provide a significant benefit to these patients.

No MeSH data available.


Related in: MedlinePlus

X-Ray chest consistent with severe cardiomegaly
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Figure 1: X-Ray chest consistent with severe cardiomegaly

Mentions: Laboratory data showed white blood cell (WBC) count 18.8 cells/μL with left shift, brain natriuretic peptide (BNP) 1,040 ng/L, and troponin-I 2.26 μg/L. Electrocardiogram (EKG) did not show significant ST-T wave changes. Chest X-ray showed severe cardiomegaly [Figure 1]. Computed tomography (CT) of the chest revealed an unusual soft tissue mass anterior to the RV [Figure 2]. Transthoracic echocardiogram revealed ejection fraction of 45%, moderate RV enlargement, moderate RV hypokinesis, and a large echo dense mass anterior to the RV compressing the RV free wall. Magnetic resonance imaging (MRI) of the chest showed a T2-signal intensity lobulated mass in the anterior epicardial space. Transesophageal echocardiogram showed a large (4 cm) complex structure exterior to the RV, consistent with right CAA. Color flow signal was noted near the RV outflow track consistent with fistulous drainage from the CAA. At the point of fistulous drainage there was large (18 × 12 mm) vegetation attached to the RV free wall [Figure 3]. The patient underwent left heart catheterization that showed a large CAA with possible fistulous drainage into the RV and triple vessel disease [Figure 4]. Surgical treatment was advised for exclusion of the CAA, closure of the fistula, excision of the vegetation, and coronary artery bypass grafting; but the patient refused surgical intervention. Subsequently, blood cultures revealed methicillin sensitive Staphylococcus aureus. Patient's overall condition improved with medical management and he was discharged to the skilled nursing facility with intravenous antibiotics and standard anti-ischemic medications.


A Rare Combination of Giant Right Coronary Artery Aneurysm.

Haider I, Suksaranjit P, Wilson B, McGann C - N Am J Med Sci (2015)

X-Ray chest consistent with severe cardiomegaly
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4525394&req=5

Figure 1: X-Ray chest consistent with severe cardiomegaly
Mentions: Laboratory data showed white blood cell (WBC) count 18.8 cells/μL with left shift, brain natriuretic peptide (BNP) 1,040 ng/L, and troponin-I 2.26 μg/L. Electrocardiogram (EKG) did not show significant ST-T wave changes. Chest X-ray showed severe cardiomegaly [Figure 1]. Computed tomography (CT) of the chest revealed an unusual soft tissue mass anterior to the RV [Figure 2]. Transthoracic echocardiogram revealed ejection fraction of 45%, moderate RV enlargement, moderate RV hypokinesis, and a large echo dense mass anterior to the RV compressing the RV free wall. Magnetic resonance imaging (MRI) of the chest showed a T2-signal intensity lobulated mass in the anterior epicardial space. Transesophageal echocardiogram showed a large (4 cm) complex structure exterior to the RV, consistent with right CAA. Color flow signal was noted near the RV outflow track consistent with fistulous drainage from the CAA. At the point of fistulous drainage there was large (18 × 12 mm) vegetation attached to the RV free wall [Figure 3]. The patient underwent left heart catheterization that showed a large CAA with possible fistulous drainage into the RV and triple vessel disease [Figure 4]. Surgical treatment was advised for exclusion of the CAA, closure of the fistula, excision of the vegetation, and coronary artery bypass grafting; but the patient refused surgical intervention. Subsequently, blood cultures revealed methicillin sensitive Staphylococcus aureus. Patient's overall condition improved with medical management and he was discharged to the skilled nursing facility with intravenous antibiotics and standard anti-ischemic medications.

Bottom Line: CAA is commonly found in the right coronary artery with significant number of cases associated with fistula formation.We describe a rare case of an 87 year-old man with large CAA with fistulous drainage into the right ventricle (RV) along with RV free wall vegetation as a cause of chronic weakness and lethargy.Giant CAA with fistulous drainage to the RV could present in the form of infective endocarditis.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Division of Cardiology, University of Utah, Salt Lake City, Utah, United States.

ABSTRACT

Context: Giant coronary artery aneurysm (CAA) in adults is a rare clinical entity with an estimated incidence of 0.02%. CAA is commonly found in the right coronary artery with significant number of cases associated with fistula formation.

Case report: We describe a rare case of an 87 year-old man with large CAA with fistulous drainage into the right ventricle (RV) along with RV free wall vegetation as a cause of chronic weakness and lethargy.

Conclusion: Giant CAA with fistulous drainage to the RV could present in the form of infective endocarditis. Early detection and surgical treatment would provide a significant benefit to these patients.

No MeSH data available.


Related in: MedlinePlus