Giant triple coronary artery aneurysms

A 59-year-old man was referred for an echocardiogram because of asymptomatic enlarged cardiac silhouette on chest radiograph (Panel A). An echocardiogram revealed a large circular echo density in the atrioventricular groove suggestive of left circumflex (LCX) coronary artery aneurysm (Panel B, LCX*, see Supplementary dataSupplementary data online, Video S1), a giant circular extra-cardiac echo density (Panel B, RCA**, see Supplementary dataSupplementary data online, Video S1) with intraluminal laminated thrombus (Panel B, white arrowheads) compressing right atrial inflow, and a cystic aneurysmal change (Panel C, RCA*, see Supplementary dataSupplementary data online, Video S2) in the proximal right coronary artery (RCA) (Panel C, black arrowheads). He had left ventricular ejection fraction of 40%. A coronary computed topographic angiogram (CCTA) demonstrated coronary aneurysms of proximal RCA (Panel D, RCA*) and mid RCA (Panel D–F, RCA**), the maximal diameter measured 110 mm with thrombus-filled lumen. Additionally, a 60-mm left anterior descending artery (LAD) aneurysm (Panel E and F, LAD*) and a 54-mm LCX aneurysm (Panel E and F, LCX*) were demonstrated. A coronary angiogram confirmed aneurysms of RCA (Panel G, see Supplementary dataSupplementary data online, Video S3), LAD, and LCX (Panel H, see Supplementary dataSupplementary data online, Video S4). Given an extremely large aneurysmal size and LV systolic dysfunction, the patient underwent coronary bypass graft surgery and aneurysmal repair and ligation.

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