ABSTRACT
A 38-year-old intravenous drug using man was scheduled for urgent pericardial window surgery to treat pericardial effusion and tamponade. Transoesophageal echocardiography (TOE) during the procedure revealed a minor residual effusion and an atypical heterogenous thickened appearance of the pericardium and adjoining aortic root. Interrogation of the aortic valve with a 'panning' manoeuvre from the mid-oesophageal aortic valve short axis view showed a small hypoechoic lesion between the right and non-coronary cusp at the level of the sinus of Valsalva. Postoperative high-resolution contrast CT confirmed the anaesthesia TOE findings of a small pseudoaneurysm. The decision was then made to proceed to formal aortic root replacement after 5 days of directed antibiotic therapy and evidence of an increase in aneurysm size to 2.7 cm on repeat CT angiogram. The patient made a good postoperative recovery and was eventually discharged from the hospital 3 weeks after his second operation.
Subject(s)
Aneurysm, False/surgery , Aneurysm, Infected/diagnostic imaging , Aortic Valve/diagnostic imaging , Aortitis/diagnostic imaging , Echocardiography, Transesophageal , Adult , Aneurysm, False/complications , Aneurysm, False/diagnostic imaging , Aneurysm, Infected/complications , Aneurysm, Infected/surgery , Angiography/methods , Aorta, Thoracic , Aortic Valve/physiopathology , Aortic Valve/surgery , Aortitis/complications , Aortitis/surgery , Cardiac Tamponade/etiology , Cardiac Tamponade/physiopathology , Cardiac Tamponade/surgery , Follow-Up Studies , Heart Valve Prosthesis Implantation/methods , Humans , Intraoperative Care/methods , Male , Pericardial Effusion/etiology , Pericardial Effusion/physiopathology , Pericardial Effusion/surgery , Risk Assessment , Severity of Illness Index , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
INTRODUCTION: Coronary artery aneurysms are seen in 1.5-5% of patients presenting for coronary angiography, but giant aneurysms, defined as being greater than 2 cm in diameter, are rare. Given the paucity of cases and limited experience in diagnosis and management of the disease, each case is a learning tool in itself. CASE PRESENTATION: We report the rare case of a 78-year-old Caucasian man who presented to a peripheral emergency department with chest pain and was subsequently found to have a giant right coronary artery aneurysm. Following initial investigation and treatment he was referred to our hospital for definitive management. CONCLUSION: The case described illustrates one of the varied presentations and subsequent management of an ill-defined and heterogeneous disease process. Given the limited experience with giant aneurysms in the coronary circulation, this case provides valuable insight into the clinical presentation of the disease and gives an example of the management of the most recent such case at our hospital.
