Category: Cardiac

Cardiac #3

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Clinical Data: 70-year-old male, asymptomatic, incidental finding on chest X-ray

What are the findings:

What are the findings:

Enlargement of the left coronary artery (LAD) and right coronary artery (RCA) with peripheral thrombus
within both vessels diagnostic of coronary artery aneurysms.

What is the most likely diagnosis:

What is the most likely diagnosis?

Coronary artery aneurysm:

Definition: coronary dilatation which exceeds the diameter of normal adjacent segments or the diameter of the patient’s largest coronary vessel by 1.5 times
Etiology: Atherosclerosis, genetic, autoimmune/inflammatory, infectious
Clinical Presentation: mostly clinically silent
Complications: local thrombosis > distal embolization and myocardial infarction; aneurysm rupture > cardiac tamponade; myocardial stenosis
Treatment: percutaneous or surgical

Cardiac #2

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Clinical Data: Young adult with chest pain.

What do you see?

What do you see?

Intra-arterial course of the right coronary artery (RCA). RCA arises from left coronary sinus (not depicted) and passes between aorta and pulmonary trunk.

List at least three other potentially life-threatening congenital coronary artery defects.

List at least three other potentially life-threatening congenital coronary artery defects.

-Anomalous aortic origin of coronary artery (AAOCA)
-Anomalous origin of the left coronary artery originating from the pulmonary artery (ALCAPA)
-Anomalous origin of the right coronary artery originating from the pulmonary artery (ARCAPA)
-Single coronary artery
-Hypoplastic right coronary artery
-Congenital coronary artery ostial stenosis or atresia
-Anomalous circumflex coronary artery arising from the right pulmonary artery (ACARPA)

Discussion:

Congenital coronary artery anomalies (CAAs) are often incidental findings. They can be classified as CAAs of origin, course, and of termination. Although they are rare and most of them are benign variants, some are associated with an increased risk of myocardial ischemia, so recognizing and reporting them is substantial.

References and further reading:

1. Gentile F, Castiglione V, De Caterina R. Coronary Artery Anomalies. Circulation. 2021 Sep 21;144(12):983-996. doi: 10.1161/CIRCULATIONAHA.121.055347. Epub 2021 Sep 20. PMID: 34543069.
2. Waterbury TM, Tarantini G, Vogel B, Mehran R, Gersh BJ, Gulati R. Non-atherosclerotic causes of acute coronary syndromes. Nat Rev Cardiol. 2020 Apr;17(4):229-241. doi: 10.1038/s41569-019-0273-3. Epub 2019 Oct 3. PMID: 31582839.

Cardiac #1

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Clinical Data: Chest pain

Coronary CT angiography was performed.

Describe salient abnormalities.

Salient abnormalities:

9 mm aneurysm arising from left anterior descending (LAD) artery. Contrast blush within pulmonary trunk near abnormal, torturous LAD branch

What is the final diagnosis?

What is the final diagnosis?

Coronary artery-to-pulmonary artery fistula with left-to-right shunt. Left coronary artery aneurysm.

Discussion:

Coronary artery-to-pulmonary artery fistula (CPAF) is a type of coronary arteriovenous fistula (CAVF), where there is an abnormal connection (fistula) between a coronary artery and either pulmonary trunk or main pulmonary artery. This condition is associated with coronary artery aneurysms (CAA), pulmonary atresia, and ventricular septal defect (VSD). Patients are usually asymptomatic; the most common clinical manifestation is chest pain and dyspnea, especially on exertion.

References and further reading:

1. Hang K, Zhao G, Su W, Bao G, Zhao Q, Jiao Z, Tian Z, Zhang H, Nie L, Luo R, Li L, Huang M, Shi L, Li S. Coronary artery-to-pulmonary artery fistula in adults: evaluation with 320-row detector computed tomography coronary angiography. Ann Transl Med. 2021 Sep;9(18):1434. doi: 10.21037/atm-21-4404. PMID: 34733986; PMCID: PMC8506747.
2. Kim H, Beck KS, Choe YH, Jung JI. Coronary-to-Pulmonary Artery Fistula in Adults: Natural History and Management Strategies. Korean J Radiol. 2019 Nov;20(11):1491-1497. doi: 10.3348/kjr.2019.0331. PMID: 31606954; PMCID: PMC6791815.