Giant Aneurysm of the Right Coronary Artery with Concomitant Destruction of the Right Lung

Objectives: Coronary artery aneurysms are uncommon and in many cases incidental findings during coronary angiography. Etiology remains often unclear. Known reasons are atherosclerosis, congenital abnormalities, infections (syphilis, mycotic), rheumatic diseases (lupus erythematosus, Kawasaki disease), trauma or iatrogenic. Most aneurysms are asymptomatic but they can be associated with chest pain. There is no consensus on its management.

Methods: A 46-year-old woman presented with dyspnea and hemoptysis in the emergency room of a district hospital. Because of an unclear rheumatic disease the patient has been treated with low dose cortisone for more than ten years. Twelve years ago a tumor of the right atrium was excised over a limited right thoracotomy. Now, CT-Scan of the chest excluded pulmonary embolism but showed a paracardial tumor with complete opacity of the right middle lobe. Because of that, the patient was transferred to our clinic. Echocardiography as well as cardiac CT showed a perfused tumor near to the right atrium; however, its origin was unclear.

Result: Suddenly patient developed acute respiratory failure with the need of intubation a mechanical ventilation. Emergency bronchoscopy showed an atrial bleeding in the right middle lobe which stopped after local injection of epinephrine. A coronary angiography was immediately done and demonstrated a giant aneurysm of the right coronary artery with no possibility of an interventional therapy. Intraoperative the right coronary artery was ligated, the aneurysm was excised and a single vein graft was used for the distal vessel. Initial recovery was unsuspicious but after a week the patient developed fever and the inflammatory markers were increased. A CT scan showed an abscess of the right lung with connection to the middle lobe bronchus and the need of an upper bilobectomy. After the second operation and a hospital stay with no further complications, patient was discharged 13 days later being in good conditions.

Conclusion: Aneurysm of the coronary arteries are rare and most of the time asymptomatic. It is possible that first symptoms are due to displacement or destructions of other organs. In the present case only coronary angiography led to the correct diagnosis.

Publication History

Article published online:
19 February 2021