Left Main Coronary Artery Diverticulum: Case Report and Review of the Literature

Abstract

Coronary artery disease is a major cause of morbidity and mortality, and while most commonly is atherosclerotic, it can present with variable manifestations, both congenital and acquired. One such manifestation is coronary aneurysm, which is a localized dilatation of a coronary artery wall segment to greater than 1.5 times the adjacent normal segments. While a dilated outpouching of a coronary artery has been commonly classified as a coronary aneurysm, a non-dilated outpouching is rare and is referred to as a diverticulum, with only one previous case report in the literature. It is conceivable that other cases of coronary artery diverticulum may have been previously reported as an aneurysm, given the overlapping angiographic appearance. We present a case of a 72-year-old female patient with an incidental finding of left main coronary artery diverticulum on diagnostic coronary angiogram done for preoperative liver transplantation evaluation.

Left main coronary artery diverticulae: a rare case

“…The diameter of LMCA was 4.06 mm. These outpouchings were <1.5 times of the adjacent native vessel diameter, excluding the criteria of aneurysm 1. The patient was advised for coronary artery bypass grafting.…”

“…The dilatation of coronary arteries is usually referred to as aneurysmal disease (focal) or ectasia (diffuse) 1. It stems from arterial wall weaknesses most commonly as a result of atherosclerosis and less commonly by other etiologies including infections, inflammation, trauma or congenital defects 1. Coronary aneurysm refers to a localised dilatation of coronary artery wall segment to greater than 1.5 times the adjacent normal segments 1.…”

“…It stems from arterial wall weaknesses most commonly as a result of atherosclerosis and less commonly by other etiologies including infections, inflammation, trauma or congenital defects 1. Coronary aneurysm refers to a localised dilatation of coronary artery wall segment to greater than 1.5 times the adjacent normal segments 1. On the contrary, a non-dilated outpouching of a coronary artery is rare and is referred to as a diverticulum, reported only twice in the literature previously 1 2.…”

“…Coronary aneurysm refers to a localised dilatation of coronary artery wall segment to greater than 1.5 times the adjacent normal segments 1. On the contrary, a non-dilated outpouching of a coronary artery is rare and is referred to as a diverticulum, reported only twice in the literature previously 1 2. Coronary diverticulum is under-recognised and under-reported likely because of its overlapping angiographic appearance with an aneurysm.…”