The following is a summary of the “No Ordinary Coronary: A Case Series of Two Large Coronary Artery Aneurysms Found on Chest X-Ray,” published in the January 2023 issue of Emergency Medicine by Degtyar, et al.
The risk of death and disability after a coronary aneurysm procedure is high. Large ones can be seen on chest X-rays even though they are more commonly detected by ultrasound or CT scans. Here, they report on 2 cases of coronary artery aneurysms diagnosed by chest x-ray: one resulting from a saphenous vein graft and the other a left anterior descending artery pseudoaneurysm discovered 1 week after cardiac catheterization.
Emergency physicians must be able to identify abnormal chest x-ray studies and screen for complications following procedures, such as coronary artery aneurysms. An aneurysm in the coronary artery is a potentially fatal condition that requires immediate diagnosis and surgical consultation. It is possible to find case reports of coronary artery aneurysms in the literature of cardiology and emergency medicine (1, 2, 3, 4). Arterial dilatation greater than 150% of the average vessel diameter constitutes an aneurysm (5).
Pseudoaneurysms do not involve all three layers of vasculature, while true aneurysms do. True aneurysms may be present at birth, or they may develop later on as a result of atherosclerotic, infectious, or inflammatory disease, blunt trauma, or connective tissue disorders. Infrequently discussed in the context of emergency medicine, saphenous vein graft aneurysm (SVGA) following coronary bypass is a well-documented but rare finding within cardiovascular surgery (one case series estimated occurrence at 0.07%) (6). Although some have been linked to Behçet’s disease, pseudoaneurysms are more uncommon and are typically associated with percutaneous coronary interventions (1,7, 8, 9, 10, 11).
Source: sciencedirect.com/science/article/abs/pii/S073646792200542X
