coronary artery aneurysm
Coronary artery aneurysms are an uncommon, predominantly incidental finding.
Coronary artery aneurysms are most common in men , likely reflecting the increased rates of atherosclerosis in men compared to women. Prevalence varies in the literature between 0.1-5% .
Most coronary artery aneurysms are asymptomatic. They can be associated with cardiac murmurs or present with chest pain or congestive cardiac failure.
Coronary artery aneurysms are defined as a focal dilatation of the coronary artery by at least 50% compared to a nearby artery or adjacent arterial segment and involve <50% of the artery length . They can be classified by :
The term coronary artery ectasia is applied when there is dilatation but it involves >50% of the artery length . The subtype, giant coronary artery aneurysms, measure > 2 cm in diameter. In some literature, a coronary artery aneurysm is labeled as "giant" if its size exceeds 5 cm .
Pathologically, coronary artery aneurysms can be classified into three groups :
- most common (50%)
- vasculitis, e.g. Kawasaki disease
- mycotic, e.g. syphilis
- congenital (~17%)
- connective tissue disorders, e.g. systemic lupus erythematosus
- iatrogenic, e.g. stent placement
- drug-related, e.g. cocaine abuse
Imaging modalities used in evaluating coronary artery aneurysms include transthoracic echocardiography, ECG-gated CT angiography, MRI and/or MR angiography, and angiographic cardiac catheterization.
Role of imaging
- depiction of coronary artery anatomy
- detection of coronary artery aneurysms
- evaluation of aneurysm shape and structure:
- morphology (fusiform or saccular)
- aneurysm diameter
- wall calcification
- luminal thrombosis
- presence of associated stenosis
- origin and termination
- monitoring of growth rate
- exclude potential complications:
- myocardial perfusion abnormalities
- fistula formation
- extrinsic mass compression
- rupture and hemopericardium
Treatment and prognosis
There is no established treatment for coronary artery aneurysms with medical and surgical options available . The five-year survival of coronary artery aneurysms is ~70% .
The differential diagnosis includes:
- sinus of Valsalva aneurysm
- aneurysm of a surgically placed coronary arterial or venous graft
- neoplasms of the heart, pericardium, or mediastinum