Ruptured coronary artery aneurysm mimicking as a giant mediastinal mass

Abstract

A 49-year-old male with chest discomfort and suspected mediastinal mass (Panel A, pentagram) was transferred to our unit. Medical history was notable for hypertension, and work-up for vasculitis and connective tissue disorders was unremarkable. Computed tomography angiography (CTA) revealed a large heterogeneous mass (85 mm × 52 mm) locating between the aorta and pulmonary artery, and a giant right coronary artery aneurysm (CAA; 29 mm × 19 mm, asterisk) was entrapped in this mass (Panels B and C). Further coronary angiography (Panel D) confirmed the diagnosis of a right CAA, and no additional coronary anomalies were observed. Transoesophageal echocardiography (Panel E; Supplementary material online, Video S1) demonstrated a circumscribed anechoic cavity adjacent to the right cardiac chambers. The patient underwent surgery through a median sternotomy. The giant mediastinal mass was opened and explored under cardiopulmonary bypass, and a large amount of...