Giant saccular aneurysm of the left main coronary artery
An 80-year-old woman was admitted with chest pain. The patient has experienced exertional chest pain for the last three days. Her medical history was unremarkable and physical examination was normal. Her ECG showed negative T waves in leads V2-V5. Cardiac enzyme levels at presentation and in hospital follow-up were normal. Echocardiography revealed a hypokinetic interventricular septum and left ventricular anterior wall and demonstrated a giant coronary artery aneurysm involving the left main coronary artery at the parasternal short axis view. The myocardial perfusion scan showed inducible ischemia in the basal anterior wall of the left ventricle. Left coronary angiography revealed a 3.0 × 2.0 cm saccular CAA originating from a distal bifurcation of the LMCA (). There were no significant lesions in the coronary arteries. Because of the inability to visualize the distal segment of the LAD due to entrapment of contrast media in the CAA, a 64-slice multidetector computed tomography coronary angiography was performed. It showed a saccular CAA at the bifurcation of LAD and circumflex artery (). Due to ischemic symptoms and its risk of rupture, surgical resection of CAA was recommended. However, she refused the surgery. At the eight month follow-up she was free of angina. Her current medications included nitrate, beta blocker, aspirin, ACE inhibitor and statin.