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(Circulation. 2007;115:e452-e454.)
© 2007 American Heart Association, Inc.

Images in Cardiovascular Medicine

The Use of 2 Contrast Filling Patterns in the Diagnosis of a Giant Coronary Aneurysm

Yun-Hyeong Cho, MD; Eui-Young Choi, MD; Se-Jung Yoon, MD; Jeehyun Lee, MD; Young-Jin Kim, MD; Jong-Won Ha, MD, PhD; Yangsoo Jang, MD, PhD; Byung-Chul Chang, MD, PhD; Namsik Chung, MD, PhD

From the Divisions of Cardiology (Y.-H.C., E.-Y.C., S.-J.Y., J.L., J.-W.H., Y.J., N.C.), Diagnostic Radiology (Y.-J.K.), and Cardiovascular Surgery (B.-C.C.), Yonsei University College of Medicine, Seoul, South Korea.

Correspondence to Eui-Young Choi, MD, Cardiology Division, Yonsei University College of Medicine, Yonsei Cardiovascular Center, CPO Box 8044, Seoul, South Korea 120–752. E-mail choi0928@yumc.yonsei.ac.kr

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 75-year-old woman was admitted for exertional dyspnea and chest pain that had been present for several months. She denied any past history of medical illness such as hypertension or diabetes, as well as any past history of significant trauma. On physical examination, no definite cardiac murmur was auscultated. A chest x-ray showed a bulging silhouette at the right border of the heart. Electrocardiographic findings showed no significant abnormalities. Two-dimensional echocardiography showed an abnormal echolucent large mass lesion at the right atrial side, suggesting an intraright atrial mass, pericardial cyst, or aneurysm. To determine the exact location of the mass and its relation to the right atrium, a contrast echocardiogram with intravenous agitated saline injection was performed. This revealed an extracardiac mass compressing the right atrium without contrast filling (Figure 1, Movie I). To clarify the communication with the left-side chamber, perfluorocarbon-exposed sonicated dextrose albumin, a pulmonary circulation passing contrast agent, was injected via an antecubital vein. Contrast echocardiogram with perfluorocarbon-exposed sonicated dextrose albumin showed contrast filling in the mass after opacification of the left ventricular cavity, suggesting a coronary aneurysm (Figure 2, Movies II and III). Additionally, an abnormal continuous flow entering into the main pulmonary artery was noted, suggesting the drainage of a giant coronary aneurysm (Figure 3, Movie IV). With this in mind, multislice computed tomography and conventional angiography were performed to confirm the diagnosis. Similar to the echocardiographic findings, a huge coronary aneurysm feeding from the right coronary artery and . . . [Full Text of this Article]

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Circulation 2007 115: 2459. [Extract] [Full Text]