Long fusiform aneurysm

An approximately 60-year-old male with worsening exertional dyspnoea was evaluated for cardiac catheterisation following a nuclear stress test that showed a suspicious area of ischaemia in the anterior wall. He was a life-long smoker with a family history of coronary artery disease. Coronary angiography (figure 1) revealed an unusually long fusiform aneurysm involving the left main coronary artery, proximal left anterior descending (LAD) and circumflex artery. The diameter of this aneurysmal segment was measured to be between 1 to 1.5 cm. Mild diffuse non-critical atherosclerotic disease was also evident in the coronary architecture distal to this aneurysm with a prominent 40% stenosis in the mid-LAD. The right coronary artery (RCA) was not dilated. No intervention was performed. Further work-up did not reveal a cause to his aneurysm. Figure 1 Coronary artery angiography showing a long coronary artery aneurysm originating from the left main coronary artery (LCA) that extends to involve the left anterior descending artery (LAD) and the circumflex artery (CXA). Also evident are several areas ... Coronary artery aneurysms are rare abnormal dilatations of a localised portion of the coronary artery, classified as congenital or acquired and saccular or fusiform. Atherosclerosis-induced aneurysms account for about 50% of aneurysms,1 are located adjacent to an atherosclerotic lesion and are caused by thinning and/or destruction of the media.2 Congenital aneurysms mostly involve the RCA, presenting as incidental findings.3 Coronary ectasia and Kawasaki disease associated aneurysmal disease are generally multiple and diffuse. Although non-invasive modalities i.e. echocardiography, computed tomography and magnetic resonance imaging are useful, coronary arteriography is now the gold standard for diagnosis of most of these aneurysms.4 Medical treatment consists of antiplatelet agents while definite management involves surgical repair of the aneurysm with a pericardial patch or with resection and coronary artery bypass.5 In this section a remarkable ‘image’ is presented and a short comment is given. We invite you to send in images (in triplicate) with a short comment (one page at the most) to Bohn Stafleu van Loghum, PO Box 246, 3990 GA Houten, l.meester@bsl.nl. ‘Moving images’ are also welcomed and (after acceptance) will be published as aWeb Site Feature and shown on our website: www.cardiologie.nl This section is edited by M.J.M. Cramer and J.J. Bax.