대한흉부영상의학회 Weekly Chest Cases

Case No : 177 Date 2001-03-17

Courtesy of Jin Seong Lee, M.D. / Asan Medical Center, Seoul, Korea
Age/Sex 66 / F
Chief ComplaintAbnormality on Chest PA on a routine checkup

Figure 1
Figure 2
Figure 3

Diagnosis With Brief Discussion

Diagnosis: Coronary artery aneurysm arising from the anterior descending left coronary artery
Radiologic Findings: PA and lateral chest radiographs show an ovoid shaped mass, overlapped with left superior cardiac margin.
It is located in anterior aspect of the cardiac silhouette on lateral chest radiograph and has thin calcified wall.

Non-enhanced CT scan demonstrates a 4 cm-sized ovoid mass that is located in interventricular septal groove and abuts to the anterior descending left coronary artery.
Contrast enhanced CT scan demonstrates the mass is enhanced as well as aorta.

Coronary angiography (below) shows an about 4 cm-sized saccular aneurysm arising from the anterior descending left coronary artery.
Brief Review: Aneurysm is uncommon for the coronary artery system.
Coronary artery aneurysms are noted in 0.2% to 4.9% of patients undergoing coronary arteriography.
The most widely accepted definition is a more than one and half times the diameter of adjacent normal segments of the largest coronary artery and is classified into being saccular or fusiform and single or multiple.
The proximal and middle segments of the right coronary artery were most frequently involved and the next most frequently involved segments were the proximal left anterior descending and circumflex coronary arteries, and multiple in 25% of patients.
Such aneurysms occur three times as frequently in men as in women.
The most common cause of the coronary artery aneurysm is atherosclerotic coronary artery disease in about half of all patients.
Other leading causes include Kawasaki disease, polyarteritis nodosa, systemic lupus erythematosus, syphilis, rheumatic fever and trauma.
The pathogenesis of coronary artery aneurysm is most likely related to injury of the intima overlying intrinsic disease of the media, causing dilatation of the vessel and intima ulceration.
Many patients are first seen with angina or myocardial infarction, but currently the diagnosis is most often obtained based on an unexpected finding at cardiac catheterization.
The patients with aneurysmal disease had a significantly higher incidence of myocardial infarction than coronary stenosis only.
The saccular aneurysms are at higher risk for rupture or thrombosis than those with fusiform aneurysms. Surgery has generally been reserved for symptomatic patients.
References: 1. Selke KG, Vemulapalli, Brodarick SA, et al. Giant coronary artery aneurysm: detection with echocardiograpy, computed tomography, and magnetic resonance imaging. Am Heart J 1991; 121:1544-1547.
2. Swaye PS, Fisher LD, Litwin BAP, et al. Aneurysmal coronary artery disease. Circulation 1983; 67:134-138.
3. Quinn VJ, Baloch Z, Chandrasekaran K, et al. Coronary artery aneurysm masquerading as a paracardiac mass on transesophageal echocardiography. Am Heart J 1994; 127:441-443.
Keywords: Vascular, Vascular,

No. of Applicants : 41

▶ Correct Answer : 23/41, 56.1%

- 嫄닿뎅
- 怨
- 怨源吏
- 怨
- 怨源
- 怨
- 怨
- 怨
- 愿二源
- 愿二
- 援
- 源吏
- 遺二쇱
-
- 諛
- 源
- 11th Air Force Hospital Byung-June Jo
- CHU Nancy-Brabois France Denis Regent
- Dong-A University Hospital Ki-Nam Lee
- Matsuyama Red Cross Hospital, Matsuyama, Japan Shunya Sunami
- Paris, France Pierre-Yves Brillet
- Seoul City Boramae Hospital Jae-Woo Song
- Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate

▶ Semi-Correct Answer : 11/41, 26.8%

- 寃쎈
- 怨
- 遺
- 源
- 蹂
-
-
- Ospedale di Fabriano, Italy Giancarlo Passarini
- Santa Maria delle Grazie Hospital-Pozzuoli, Naples, Italy Bianca Cusati
- Seoul National University Hospital moon sung gyu
- Seoul National University Hospital Tae Jung Kim

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 177 Date 2001-03-17

Discussion

No. of Applicants : 41