From Asahi University, the Division of Cardiology, Murakami Memorial
Hospital, Hashimoto-cho, Gifu, Japan.
Correspondence to Masahiko Satoda, MD, 2nd Department of Internal Medicine, Kyoto Prefectural University of Medicine, Kawaramachi: Hirokozi, Kamikyo-ku, Kyoto, Japan.
A 26-year-old man,
previously in good health, was transferred to the emergency unit of our
hospital on July 19, 1995; however, he was dead on arrival. He was an
employee of a machine industry with no history of chest pain or
palpitation, and at company checkups, no abnormalities were pointed out
except for marked left hilar calcification on chest radiograph in June
1991 (Fig 1
A small, fresh hematoma was seen on the epicardial surface close
to the proximal left anterior descending coronary artery (Fig 2A
Histologically, diffuse intimal thickening was seen
throughout the epicardial artery, and leukocyte infiltration into the
adventitia and vasa vasorum was seen around the aneurysm,
indicating persistent mild vasculitis of the artery (Fig 4
Footnotes
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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References
1.
Virmani R, Robinowitz M, Atkinson JB, Forman MB,
Silver MD, Mcallister HA. Acquired coronary
arterial aneurysms: an autopsy study of 52
patients. Hum Pathol.. 1986;17:575-583.[Medline]
[Order article via Infotrieve]
2.
Melish ME, Hicks RH, Larson EJ. Mucocutaneous
lymph node syndrome in the United States. Am J Dis
Child. 1976;130(6):599-607.
3.
Everett ED. Mucocutaneous lymph node syndrome
in adults. JAMA.. 1979;242:542-543.
4.
Fujiwara T, Fujiwara H, Nakano H. Pathological
features of coronary arteries in children with Kawasaki disease
in which coronary arterial aneurysm was
absent at autopsy. Circulation. 1988;78:345-350.
© 1998 American Heart Association, Inc.
Images in Cardiovascular Medicine
Sudden Death Due to Rupture of Coronary Aneurysm in a 26-Year-Old Man
); moreover, when he was 1
year old, he suffered from an acute self-limited febrile illness
with diffuse erythematous macular rash followed by membranous
desquamation of the fingertips and notable conjunctival infection
resembling Stevens-Johnson syndrome or mucocutaneous lymph node
syndrome that occurred 2 years after the first description of Kawasaki
disease.1 About half an hour before admission, he had
suddenly lost consciousness while playing catch during the noon break.
Despite cardiopulmonary resuscitation, he died, and an autopsy
was performed immediately.
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Figure 1. Chest radiograph showing small left hilar
calcification (arrow). ). The true lumen was heavily calcified
and stenotic, and the pseudolumen was coated internally with a
smooth intimal membrane (Fig 2B). A postmortem angiogram (Fig 3) revealed that the saccular
aneurysm communicated with the true lumen. The circumflex
artery was also depicted, suggesting that there was
no thrombotic occlusion of the left descending artery, and
secondary strangulation of the true lumen due to the aneurysm
rupture might have evoked an anteroseptal acute myocardial infarction
(Fig 3).
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Figure 2. A, Anterior surface of left ventricle showing
small, dark-colored hematoma around proximal left descending
coronary artery (arrowheads). B, When epicardium was removed,
true lumen (arrow) was revealed to be heavily calcified and
stenotic; saccular aneurysm was depicted
posteriorly (arrowheads).
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Figure 3. Postmortem angiogram; radiographic
contrast agent was injected retrogradely into left anterior descending
coronary artery. Saccular aneurysm was depicted
(arrow), then medium disclosed tributary of circumflex artery
(arrowheads), showing that there was no complete obstruction of true
lumen of left anterior descending coronary artery. Ao indicates
acending aorta; asterisk, left sinus of Valsalva and left main
trunk. ). Rupture of a coronary
aneurysm is more common in the acute or subacute phase of
Kawasaki disease,2 3 4 but to the best of our knowledge,
our report is the first case in the literature of mucocutaneous lymph
node disease of aneurysm rupture due to persistent vasculitis
at the healed stage more than 10 years after disease onset. Further
discussion is needed, including therapeutic options for
non–aspirin-treated patients.
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Figure 4. A, Photomicrographs of small epicardial
coronary artery showing marked intimal thickening and
destruction of intimal lamina, but no inflammatory infiltration was
seen in this section (magnification x60; hematoxylin-eosin stain). B,
Photomicrograph of epicardial coronary artery near
aneurysm showing inflammatory cell infiltration into
adventitia. Predominant cells are lymphocytes and plasma cells
(magnification x400).
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