EURORAD ESR

Case 10676

A strange cause of coronary artery aneurism: Behcet disease

Author(s)
Mesa Garcia J (MD), Castrillo Maortua A (MD), Hormaza Aguirre N (MD), Gonzalez Sanchez R (MD), Gandiaga Mandiola A (MD) , Peña Sarnago JM (PhD).

Bilbao
Email:julimesa7@hotmail.com
 
Patient
male, 28 year(s)
 
 
  • Figure 1
    Pulmonary angiography CT

    CT pulmonary angiography to rule out pulmonary embolism. An apparent filling defect in right heart.

     
    Area of Interest: Cardiac; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;
     
     
  • Figure 2
    Cardiac Magnetic Resonance
     

    Axial T1 weighted sequence (black blood sequence). An hyperintense image on the atrioventricular sulcus (red arrow)

     
    Area of Interest: Cardiac; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;

    Balanced sequence, short axis. The same hyperintense image on the atrioventricular sulcus, with a mural thickening (red mark).

     
    Area of Interest: Cardiac; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    Perfusion sequence, short axis. Gradual and progressive filling of that pseudomass (red arrows), suggesting its vascular origin. The mural thickening seems to be a thrombus (orange line).

     
    Area of Interest: Cardiac; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    LGE sequence: subendocardial pathological LGE with more than 50% of myocardial involvement, affecting the inferior apical segments.

     
    Area of Interest: Cardiac; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;
     
     
  • Figure 3
    Conventional Coronary Angiography

    Conventional angiography of the RCA. The white arrows show a filling of the vascular structure corresponding to an aneurysm depending on the RCA.

     
    Area of Interest: Cardiac; Imaging Technique: Catheter arteriography; Procedure: Diagnostic procedure; Special Focus: Aneurysms;
     
     
  • Figure 4
    Coronary CT angiography
     

    Anterior (A) and posterior (B) view of the coronaries. Aneurysm depending on RCA with posterior stenosis. PDA connecting with left phrenic artery. (a: aneurysm, PDA: descending artery, LFA: phrenic artery, St:...

     
    Area of Interest: Cardiac; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    Curved reconstruction along the PDA axis, showing its communication with the phrenic artery. (t: mural thrombus; PDA: posterior descending artery; LFA: left phrenic artery)

     
    Area of Interest: Cardiac; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    A detail from the proximal RCA and the aneurysm. (t: mural thrombus; LV: left ventricle)

     
    Area of Interest: Cardiac; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    Cardiac VR: the thrombus in the atrioventricular sulcus.

     
    Area of Interest: Cardiac; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    VR. Anatomic detail of the origin and course of the RCA, its aneurysm and mural thrombus (t), the stenosis segment (orange arrow), and the communicating branche (yellow arrow) with the left phrenic artery (LFA)

     
    Area of Interest: Cardiac; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Aneurysms;
     
     
  • Figure 5
    Cardiac CT after surgery
     

    Post surgery control triple rule out CT, axial images. The aneurysm has been excluded (red arrow). A bypass from the left internal mammary artery (LIMA) to the ADA (orange arrow).

     
    Area of Interest: Cardiac; Imaging Technique: CT-Angiography; Procedure: Treatment effects; Special Focus: Aneurysms;

    VR of the postsurgical coronary tree. There is a gap in the location of the excluded aneurysm (green arrow). Distal RCA is fed by collaterals. We can see the bypass (b) to distal ADA.

     
    Area of Interest: Cardiac; Imaging Technique: CT-Angiography; Procedure: Treatment effects; Special Focus: Aneurysms;

    Curved reconstructions of the LIMA bypass, showing that it is permeable.

     
    Area of Interest: Cardiac; Imaging Technique: CT-Angiography; Procedure: Treatment effects; Special Focus: Aneurysms;
     
     
CT pulmonary angiography to rule out pulmonary embolism. An apparent filling defect in right heart.
 
Axial T1 weighted sequence (black blood sequence). An hyperintense image on the atrioventricular sulcus (red arrow)
 
Balanced sequence, short axis. The same hyperintense image on the atrioventricular sulcus, with a mural thickening (red mark).
 
Perfusion sequence, short axis. Gradual and progressive filling of that pseudomass (red arrows), suggesting its vascular origin. The mural thickening seems to be a thrombus (orange line).
 
LGE sequence: subendocardial pathological LGE with more than 50% of myocardial involvement, affecting the inferior apical segments.
 
Conventional angiography of the RCA. The white arrows show a filling of the vascular structure corresponding to an aneurysm depending on the RCA.
 
Anterior (A) and posterior (B) view of the coronaries. Aneurysm depending on RCA with posterior stenosis. PDA connecting with left phrenic artery. (a: aneurysm, PDA: descending artery, LFA: phrenic artery, St: stenosis, orange arrow: communication)
 
Curved reconstruction along the PDA axis, showing its communication with the phrenic artery. (t: mural thrombus; PDA: posterior descending artery; LFA: left phrenic artery)
 
A detail from the proximal RCA and the aneurysm. (t: mural thrombus; LV: left ventricle)
 
Cardiac VR: the thrombus in the atrioventricular sulcus.
 
VR. Anatomic detail of the origin and course of the RCA, its aneurysm and mural thrombus (t), the stenosis segment (orange arrow), and the communicating branche (yellow arrow) with the left phrenic artery (LFA)
 
Post surgery control triple rule out CT, axial images. The aneurysm has been excluded (red arrow). A bypass from the left internal mammary artery (LIMA) to the ADA (orange arrow).
 
VR of the postsurgical coronary tree. There is a gap in the location of the excluded aneurysm (green arrow). Distal RCA is fed by collaterals. We can see the bypass (b) to distal ADA.
 
Curved reconstructions of the LIMA bypass, showing that it is permeable.
 
 
 
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