Spontaneous rupture of a giant coronary artery aneurysm causing cardiac tamponade: A case report

Suspected contained rupture of a coronary artery aneurysm followed by a re-rupture: a case report

Background

Most coronary artery aneurysms (CAAs) are clinically asymptomatic and are only detected incidentally during cardiac imaging. However, CAAs can cause fatal complications such as cardiac tamponade following a rupture. Reports of contained ruptures of CAAs are limited.

Case summary

An 89-year-old man had a severe, acute-onset chest pain 2 days prior. The patient was referred to our hospital because of residual dyspnoea and a fever. The blood tests exhibited high C-reactive protein and D-dimer levels; moreover, contrast-enhanced computed tomography (CT) and transthoracic echocardiography revealed a diffuse mild pericardial effusion, which had not been detected six months prior. The fever and pericardial effusion persisted, and the main cause was not clearly understood. On Day 19, the patient had a sudden loss of consciousness after chest pain. Contrast-enhanced CT showed an increase in the pericardial effusion, and coronary angiography showed a CAA in the proximal right coronary artery with extravasations that probably sealed. A re-rupture following a contained rupture of the CAA was considered, and it was suspected that the prolonged fever and pericardial effusion were related to the contained rupture associated with the first episode of chest pain.

Discussion

Our case showed that a contained rupture of a CAA can cause a fatal event by a re-rupture and may present with a prolonged fever and pericardial effusion. A contained rupture of a CAA should be considered as a differential diagnosis in patients with a prolonged fever and pericardial effusion of unknown origin after an acute onset of chest pain.

Case Report: Not a Mediastinal Mass! a Ruptured Giant Coronary Aneurysm That Occurred in a Young Man

Introduction

Coronary artery aneurysm (CAA) is a localized coronary artery dilatation that exceeds 1. 5 times the diameter of a standard adjacent segment or the largest coronary vessel. When the expansion is > 2 cm, it is called a “giant” coronary artery aneurysm. Giant coronary artery aneurysm rupture is extremely rare and fatal.

Case presentation

We present a rare case of a 27 years old male with a giant coronary artery aneurysm rupture, but no catastrophic events occurred immediately. He was initially misdiagnosed as having a mediastinal mass with CT (computed tomography). The cardiac ultrasound showed no pericardial effusion. But The cardiac CTA (computed tomography angiography) showed a giant coronary aneurysm rupture with hematoma formation. He eventually underwent surgery and was followed up for 2 months without complications.

Conclusion

We report this case of a ruptured giant coronary aneurysm because of its infrequent occurrence in coronary artery disease. It is tough to distinguish this disease from a mediastinal tumor, and chest MRI and cardiac CTA are crucial tests. Finally, surgical resection may be the right choice for coronary aneurysm rupture. More cases need to be reported to facilitate the preoperative diagnosis of this rare coronary aneurysm.

Unique Findings and Novel Treatment Strategy of a Giant Coronary Artery Aneurysm Associated with a Significant Pericardial Effusion

Giant coronary artery aneurysms are a rare, asymptomatic occurrence. Presently, there is a lack of substantial research performed in the U.S., likely due to its low prevalence. As we are increasingly becoming a global community, strengthening data for seemingly rare disease processes such as this need to be addressed, particularly when they can progress to involve complications such as pericardial effusion caused by aneurysmal rupture or infection. A popular treatment option for these aneurysms is polytetrafluoroethylene-covered stents; they have been favorable with obtaining a high percentage of procedural success rates in aneurysms not associated with myocardial infarctions. In this paper, we present a case of a giant coronary artery aneurysm located in the left circumflex coronary artery that was complicated by a pericardial effusion. We will also present its unusual repair using a long drug-eluting stent as a scaffold to overlap covered coronary stents used to help exclude the aneurysm.

Giant aneurysm of the left atrial branch of the left circumflex artery with fistula

Giant coronary artery aneurysm with a fistula is a rare condition. We present one of the largest aneurysms of left circumflex coronary artery territory, arising from the left atrial branch of the left circumflex coronary artery. It had a maximum diameter of 10 cm, with a fistulous connection to the right atrium. Total exclusion of the aneurysmal mass was achieved by ligation of the afferent artery, closure of the entry point from within the aneurysm, and closure of the fistulous communication from within the right atrium. The patient's postoperative course was uneventful.