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Posts Tagged ‘coronary artery aneurysm’

Presentation

A 38-year-old women,with  episodic chest discomfort, mild dyspnea, and occasional non-productive cough. She was investigated in a non-emergent fashion.  After an abnormal X-ray chest, A CT scan was requested.  (*X-ray chest is Intentionally not posted here to add some curiosity factor)

This is probably one of the most curious Images in cardiology I have stumbled upon. At the first look, it seemed a baseball has replaced a heart. Is it not?

Most curious Image in cardiology

Posted with Creative Commons Attribution License CC-BY 3.0. Afzal et al. Dept of Internal Medicine, Florida Hospital, Orlando, USA.Cureus 10(11): e3566.

When you see such a large round shadow occupying an area exclusive meant for the heart what will you think? The following thoughts came in.

  • A Hydatid cyst of heart ?
  • An Aneurysm from a chamber of the heart?
  • Pericardial mass
  • A granulomatous cardiac mass
  • Aortic aneurysm?
  • A mediastinal mass (Teratoma, Lymphoma)
  • A foreign body?

Answer: It turned out to be none of the above. The best part is this woman was diagnosed, undergone surgery and cured of the condition.

Find out from the link and read yourself about this curious case report from  online journal Cureus, . Hats off to this journal, doing a great job of dissemination of knowledge without much restriction as other peer-reviewed ones do.

 

Acknowledgment 

Original source of Image  : Afzal A, Mobin S, Sharbatji M, et al. (November 09, 2018) Rare Case of Giant Asymptomatic Left Coronary Artery Aneurysm of 10 cm Associated with Coronary Cameral Fistula. Cureus 10(11): e3566.

Reference

A review of giant coronary artery aneurysm

1.Crawley PD, Mahlow WJ, Huntsinger DR, Afiniwala S, Wortham DC: Giant coronary artery aneurysms: review and update. Tex Heart Inst J. 2014, 41:603-608. 10.14503/THIJ-13-3896

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Coronary artery dilatation is a less discussed entity in clinical cardiology .It is important to realise  coronary artery has one more behavioral pattern in response to atherosclerosis .  Atherosclerosis not necessarily means obstructive disease . Dilatation is also  a common  expression of coronary atherosclerosis .

It all depends upon the medial weakness and resistance.If the medial weakness  is more plaque grows inwards ,  if the resistance  is more plaque grows out.(Read the related topic -Glagovian phenomenon )

What is the difference between aneurysm and ectasia?

The difference between ectasia, aneurysm are often subtle and  mainly  semantic. . If the length of the dilated segment is more than 50 % of diameter it is called ectasia. When  the diameter is more than 50 % of length it is termed aneurysm .( With a  minimal enlargement of 150 % of the reference segment.  To add to the  complexity both can occur in the same vessel.

Here is the patient from our institute  who has an Aneurysm in LAD and ectasia in RCA.



Clinical Implication

  • Ectasia generally do not limit blood flow.
  • Thrombus formation in the walls can be  common.

*Obstructive Ectasia.This can happen  either when ectasia develops in  an obstructive  lesion or a ectatic lesion getting obstructed .

Stenting and ectasia .

Ectasia creates special  challenges in the Interventional era. Stenting an ectatic segment confers  a real danger ,   as  these stents are prone for  dislodgement   or  even collapse  into the lumen or  migrate downstream   triggering an  ACS. In fact , such complications of PCI are never recognised  and hence not  reported.

Final message

Coronary artery dilatation is also an  important pathological state like coronary  stenosis . Since it rarely limits the blood flow  in  isolation  , it is a less respected lesion.

But , interventional cardiologists beware :  PCI in a ectatic vessels can give you (And your patients too !)  sleepless nights .

Treatment of isolated ectatic segments is controversial .Less aggression is always better . CAD risk factor profile management  is adviced . If severe ectatic changes  are present   it is a good practice to add  oral anticoagulants like Warfarin. Surgical excision of aneurysm is rarely required.

Kawasaki disease is a distinct entity that need to be addressed separately in pediatric population.

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