Spectrum of Coronary Artery Aneurysms:From the Radiologic Pathology Archives

Abstract

Advances in medical diagnosis reveal that coronary artery aneurysms (CAAs) may develop in several clinical scenarios and manifest variable symptoms, imaging appearances, and outcomes. Aneurysms are pathologically classified into three groups: atherosclerotic, inflammatory, and noninflammatory. The last category is associated with congenital, inherited, and connective tissue disorders. Overlap exists among the groups, because secondary atherosclerotic change may be present in an aneurysm of any cause. Atherosclerosis is the most common cause of CAAs in adults, and inflammation is considered the underlying mechanism. In children, Kawasaki disease is the most likely cause of CAAs. In both conditions, the aneurysms are usually multiple and affect more than one coronary artery. Mycotic (infectious), iatrogenic, and cocaine-induced CAAs are also well documented. Most CAAs are discovered incidentally, but potential cardiovascular complications include thrombosis, occlusion, fistula formation, rupture, myocardial infarction, and cardiac tamponade. Imaging modalities to evaluate a suspected CAA include transthoracic echocardiography, angiographic cardiac catheterization, electrocardiographically gated computed tomographic angiography, cardiac magnetic resonance (MR) imaging, and MR angiography. Management is usually individualized, and options include surveillance, anticoagulant therapy, percutaneous stent or coil placement, surgical resection, and coronary artery bypass grafting.

Giant Intramyocardial Aneurysm in a Patient with Intercoronary Communication between the Left Circumflex Artery and Right Coronary Artery: A Case Report

“…CAA constitutes localized dilation of a coronary artery segment by more than 1.5-fold, tions; with these causes, most CAAs occur along major coronary arteries in the epicardial space (1)(2)(3)(4). IMCA as exhibited in our patient is very rare with an unknown incidence; extensive review of the literature revealed a case report that introduced IMCA arising from the septal branch of the left anterior descending artery (LAD), secondary to primary percutaneous transluminal coronary angioplasty (5).…”

Multimodality Imaging of a Giant Circumflex Coronary Artery Aneurysm in a Septuagenarian

“…Multimodality imaging provides excellent assessment of coronary artery aneurysms. 9,10 Transthoracic echocardiography is useful for detection of the aneurysm and assessment of left and right ventricular function and hemodynamic evaluation, but transesophageal echocardiography allows a more detailed anatomic assessment of the aneurysm. Multidetector cardiac computed tomography provides useful information about the size, extent, and relationship of the aneurysm to adjacent structures.…”

Coronary artery aneurysm in kawasaki disease

“…CAAs can undergo luminal thrombosis. [ 3 ] Over time, these findings can lead to myocardial ischemia with resultant ischemic cardiomyopathy, scarring, and remodeling.…”