Giant coronary artery aneurysm mimicking a paracardiac mass.
Although either coronary artery aneurysm or coronary arterio-venous fistula may be found infrequently during coronary angiography, it is very rare to see combination of both structures. Here we present a case of coronary artery fistula combined with a large aneurysm. The aneurysm resembled a mass just beside the left heart border in the chest X-ray (CXR) film. The patient came to our hospital for chest pain. A grade 2/6 continuous murmur was noted over left upper sternal border. The mass was proved to be a coronary artery aneurysm at last by coronary angiogram after many examinations. Two coronary aterio-venous fistulae were also noted. This reminded us that coronary artery aneurysm could be one of the differential diagnoses of paracardiac mass during the interpretation of a CXR film. A high level of suspicion and a detailed physical examination combined with an adequate image studies, (such as echocardiography, computed tomography, magnetic resonance image, or coronary angiography) may provide accurate diagnosis and avoid painful, invasive examinations.
Yang
Teng-Yao
TY
First Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei.
Cheng
Nye-Jan
NJ
Chang
Chi-Jen
CJ
Lai
Mei-Cheng
MC
Ko
Yu-Lin
YL
D000368:Aged; D001164:Arteriovenous Fistula / Q000175:diagnosis; D003323:Coronary Aneurysm / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans