Mega-giant coronary aneurysm: antithrombotic therapy is an option

A 69-year-old man with a history of hypercholesterolaemia presented to the emergency department with atypical chest pain. Physical examination was normal and ECG showed no evidence of ischaemic changes. Laboratory studies were notable for a D-dimer level of 1842 ng/mL (reference value <500 ng/mL) and the troponin I level was normal.

Chest X-ray was normal. Chest CT angiography ruled out a pulmonary embolism but showed a giant and extensive aneurysm of the right coronary artery (RCA) up to 45 mm in diameter with a partly thrombosed lumen and evidence of right ventricle compression on four-chamber view (figures 1 and 2). The volume of the aorta and the RCA appeared similar (figure 3). Doppler echocardiography did not demonstrate right or left heart haemodynamic abnormalities.

Figure 1

Coronary CT angiography in four-chamber view, evidence of external diameter with arrow and coronary lumen with head arrow.

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