Author + information
- Received May 29, 2014
- Revision received July 14, 2014
- Accepted July 22, 2014
- Published online January 1, 2015.
- Roderick C. Deaño, MD, MPH∗,
- Ashish M. Shah, MD∗,
- Zarrish S. Khan, MD†,
- Geoffrey Bergman, MD∗,
- Mary J. Roman, MD∗,
- Rajesh V. Swaminathan, MD∗,
- Luke K. Kim, MD∗,
- Dmitriy N. Feldman, MD∗,
- Robert M. Minutello, MD∗,
- S. Chiu Wong, MD∗,
- Navneet Narula, MD‡,
- Arash Salemi, MD† and
- Harsimran S. Singh, MD, MSc∗,§∗ ()
- ∗Division of Cardiovascular Disease, Department of Medicine, New York–Presbyterian Hospital, Weill Cornell Medical College, New York, New York
- †Department of Cardiothoracic Surgery, New York–Presbyterian Hospital, Weill Cornell Medical College, New York, New York
- ‡Department of Clinical Pathology and Laboratory Medicine, New York–Presbyterian Hospital, Weill Cornell Medical College, New York, New York
- §Division of Pediatric Cardiology, Department of Pediatrics, New York–Presbyterian Hospital, Weill Cornell Medical College, New York, New York
- ↵∗Reprint requests and correspondence:
Dr. Harsimran S. Singh, Weill Cornell Medical College, New York–Presbyterian Hospital, Greenberg Division of Cardiology, 520 East 70th Street, Starr 4, New York, New York 10021.
A 41-year-old man with epigastric pain and nephrolithiasis was found to have an incidental large anterior mediastinal mass on computed tomography (Figure 1A). Transthoracic echocardiography was suggestive of a giant coronary aneurysm (GCA) versus pericardial cyst (Figure 1B, Online Videos 1 and 2). Coronary angiography confirmed a massive right coronary artery (RCA) aneurysm measuring 9 cm (Figure 1C, Online Video 3) with calcified aneurysmal dilation of the left anterior descending (LAD) artery with 100% mid-LAD occlusion and an ectatic proximal left circumflex coronary artery (LCX) (Figure 1D). Cardiac surgery was performed including proximal resection and distal ligation of the giant RCA aneurysm and bypass grafting of the LAD and LCX (Figure 1E). Pathology specimens confirmed dilated segments of muscular artery with transmural fibrosis and residual elastic lamina with no active vasculitis (Figure 1F). Whole-body positron emission tomography scanning did not demonstrate any definitive evidence of vasculitis. The patient’s aneurysms were likely sequelae from childhood Kawasaki’s disease (KD). One study followed 594 children with acute presentations of KD for a mean of 13.6 years and found that 25% of patients had evidence of coronary aneurysms, with 49% of aneurysms regressing in 6 to 18 months on subsequent cardiac catheterization (1). Two percent of those with KD in this study had multiple GCAs in multiple coronary arteries with some evidence at the time of systemic involvement (1). Given the propensity for GCAs to form thrombus despite antiplatelet therapy (1), anticoagulation with warfarin was recommended but refused by the patient. He currently remains on dual antiplatelet therapy.
For supplemental videos, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 29, 2014.
- Revision received July 14, 2014.
- Accepted July 22, 2014.
- American College of Cardiology Foundation