coronary artery aneurysm

This image
is part of a series which can be scrolled interactively with the mousewheel or mouse dragging. This is done by using Template:Imagestack. The series is found in the category Kawasaki disease coronary aneurysms - case 001. Kawasaki-Syndrom: (mäßig ausgeprägte) Aneurysmen der Koronarien bei einem 50-jährigen, der in der Kindheit an einem Kawasaki-Syndrom erkrankt war. - 3D-Rekonstruktion VR aus einem Cardio-CT-Datensatz.
Wikipedia • CC BY-SA 3.0
Coronary
artery aneurysms in Kawasaki disease. CT coronary angiography showing fusiform aneurysmal dilatation of proximal Left Anterior Descending (LAD) artery.
www.eurorad.org • CC by-nc-sa-4.0
Coronary
arteriovenous fistula • Coronary artery aneurysm and fistula - Ganzer Fall bei Radiopaedia
Hacking C, Coronary artery aneurysm and fistula. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-35175 • CC by-nc-sa 3.0 (modified)
Congenital
coronary artery anomalies • Right coronary artery aneurysm - Ganzer Fall bei Radiopaedia
Taylor J, Right coronary artery aneurysm. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-13821 • CC by-nc-sa 3.0 (modified)
Coronary
artery aneurysms in Kawasaki disease. CT coronary angiography showing diffuse fusiform aneurysmal dilatation of entire proximal, mid & distal Right Coronary Artery (RCA) with intervening areas of decrease calibre.
www.eurorad.org • CC by-nc-sa-4.0
Coronary
artery aneurysms in Kawasaki disease. CT coronary angiography showing fusiform aneurysmal dilatation of left circumflex artery.
www.eurorad.org • CC by-nc-sa-4.0
Concurrent
coronary artery and subclavian arterial aneurysms in Takayasu arteritis. a Cardiac triggered navigator-gated 3D bSSFP Noncontrast MR angiogram MIP image in parasagittal view showing aneurysmal dilation of right coronary ostium (red arrow) and fusiform aneurysmal dilation of Left main coronary artery (blue arrow). b MR angiogram in oblique coronal plane showing fusiform aneurysmal dilation of Left main coronary artery (blue arrow) followed by short segment total occlusion of proximal left anterior descending artery and diffusely narrow calibre distal vessel (dotted arrow)
ejrnm.springeropen.com • CC-by-4.0
This image
is part of a series which can be scrolled interactively with the mousewheel or mouse dragging. This is done by using Template:Imagestack. The series is found in the category Kawasaki disease coronary aneurysms - case 001. Kawasaki-Syndrom: (mäßig ausgeprägte) Aneurysmen der Koronarien bei einem 50-jährigen, der in der Kindheit an einem Kawasaki-Syndrom erkrankt war. - 3D-Rekonstruktion in MIP aus einem Cardio-CT-Datensatz.
Wikipedia • CC BY-SA 3.0
Insights into
imaging of aortitis. A 24-year-old male with Behçet"s disease. Axial CT image shows ruptured pseudoaneurysm of the left anterior descending coronary artery (white arrow) with accompanying haematoma (white asterisk)
insightsimaging.springeropen.com • CC-by-2.0
Significant
incidental cardiac disease on thoracic CT: what the general radiologist needs to know. a Axial contrast enhanced CT image demonstrating a coronary artery aneurysm (a) of the left anterior descending coronary artery (black arrow) in a 56-year-old female who was being evaluated for aortic disease. b Multiplanar reformatted images in the sagittal oblique plane also demonstrate the aneurysm (a) of the left anterior descending coronary artery (black arrow). A aneurysm, AO aorta, PA pulmonary artery, LA left atrium, LSPV left superior pulmonary vein. Please note that this examination was an ECG gated aortic CTA, but images were included as it was such a good example of coronary artery aneurysm
insightsimaging.springeropen.com • CC-by-4.0
LAD is
ectatic; largest aneurysm = 6.5 mm in diameter. Not shown is a similar sized RCA aneurysm
Wikipedia • CC BY 3.0
Aneurysmatische
Erweiterung der Herzkranzgefäße im Rahmen eines Kawasakisyndroms
Wikipedia • Public domain
This image
is part of a series which can be scrolled interactively with the mousewheel or mouse dragging. This is done by using Template:Imagestack. The series is found in the category Kawasaki disease coronary aneurysms - case 001. Kawasaki-Syndrom: (mäßig ausgeprägte) Aneurysmen der Koronarien bei einem 50-jährigen, der in der Kindheit an einem Kawasaki-Syndrom erkrankt war. - VR aus Cardio-CT-Datensatz.
Wikipedia • CC BY-SA 3.0
This image
is part of a series which can be scrolled interactively with the mousewheel or mouse dragging. This is done by using Template:Imagestack. The series is found in the category Kawasaki disease coronary aneurysms - case 001. Kawasaki-Syndrom: (mäßig ausgeprägte) Aneurysmen der Koronarien bei einem 50-jährigen, der in der Kindheit an einem Kawasaki-Syndrom erkrankt war. - VR aus Cardio-CT-Datensatz.
Wikipedia • CC BY-SA 3.0
This image
is part of a series which can be scrolled interactively with the mousewheel or mouse dragging. This is done by using Template:Imagestack. The series is found in the category Kawasaki disease coronary aneurysms - case 001. Kawasaki-Syndrom: (mäßig ausgeprägte) Aneurysmen der Koronarien bei einem 50-jährigen, der in der Kindheit an einem Kawasaki-Syndrom erkrankt war. - Cardio-CT-Datensatz.
Wikipedia • CC BY-SA 3.0
This image
is part of a series which can be scrolled interactively with the mousewheel or mouse dragging. This is done by using Template:Imagestack. The series is found in the category Kawasaki disease coronary aneurysms - case 001. Kawasaki-Syndrom: (mäßig ausgeprägte) Aneurysmen der Koronarien bei einem 50-jährigen, der in der Kindheit an einem Kawasaki-Syndrom erkrankt war. - 3D-Rekonstruktion in MIP aus einem Cardio-CT-Datensatz.
Wikipedia • CC BY-SA 3.0
Coronary
artery aneurysm • Coronary artery aneurysms with giant thrombosed right coronary aneurysm - Ganzer Fall bei Radiopaedia
Ho F, Coronary artery aneurysms with giant thrombosed right coronary aneurysm. Case study, Radiopaedia.org (Accessed on 06 Aug 2024) https://doi.org/10.53347/rID-73231 • CC by-nc-sa 3.0 (modified)
Radiopaedia • CC-by-nc-sa 3.0 • de

Coronary artery aneurysms are an uncommon, predominantly incidental finding.

Epidemiology

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% .

Clinical presentation

Most coronary artery aneurysms are asymptomatic. They can be associated with cardiac murmurs or present with chest pain or congestive cardiac failure.

Pathology

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 .

Etiology

Pathologically, coronary artery aneurysms can be classified into three groups :

  • atherosclerotic
    • most common (50%)
  • inflammatory
  • non-inflammatory 
    • congenital (~17%)
    • connective tissue disorders, e.g. systemic lupus erythematosus
    • trauma
    • iatrogenic, e.g. stent placement
    • drug-related, e.g. cocaine abuse
Associations

Coronary artery aneurysms may be associated with coronary arteriovenous fistulas to either cardiac veins or cardiac chambers.

Radiographic features

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% .

Differential diagnosis

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

See also

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Aneurysma Koronararterien:
Polyarteriitis
nodosa
intarchmed.biomedcentral.com • Open Access
Ehlers-Danlos
syndrome
Wikipedia • CC BY 2.5
Marfan-Syndrom
 
pediatricimaging.org • CC-by-nc-sa 4.0
Takayasu-Arteriitis
 
pediatricimaging.org • CC-by-nc-sa 4.0
Kawasaki-Syndrom
 
Wikipedia • CC BY-SA 3.0
syphilitische
Aortitis
www.eurorad.org • CC by-nc-sa-4.0
Aneurysma
spurium der Koronararterien
www.eurorad.org • CC by-nc-sa-4.0