Incidental Finding of Coronary Artery Aneurysm in a Patient With Unexplained Back and Shoulder Pain

In a 71-year-old female patient with unexplained back and shoulder pain, a native chest CT scan performed as part of the work-up revealed a partially calcified mediastinal mass lateral to the pulmonary trunk. Prior to a thoracic surgical procedure to diagnose the lesion, a contrast-enhanced chest CT scan was obtained for intervention planning (Figure a). The 5 cm × 5.5 cm mass appeared as a partially thrombosed coronary artery aneurysm with coarse calcifications. A complementary diagnostic coronary angiography confirmed the finding of a saccular aneurysm of a centrally originating diagonal branch of the left anterior descending artery. Ultimately, elective coil embolization of the aneurysm and the aneurysmal neck with 37 metal coils was performed in an interdisciplinary procedure involving both cardiologists and radiologists. On the final follow-up imaging, the coronary artery aneurysm was completely excluded from the blood flow (Figure b). After the intervention, dual antiplatelet therapy with aspirin (lifelong) and clopidogrel for 4 weeks was initiated. For her back pain, the patient received orthopedic treatment based on the findings of an additional orthopedic work-up. The back pain was found to be not directly related to the coronary artery aneurysm.

Figure

Contrast-enhanced chest computed tomography

Dr. med. Christian Marx, Prof. Dr. med. Daniel Thomas, Klinik für Diagnostische und Interventionelle Radiologie, St. Vinzenz-Hospital, Köln, [e-mail]

Prof. Dr. med. Jan-Malte Sinning, Klinik für Kardiologie, St. Vinzenz-Hospital, Köln

Conflict of interest statement: The authors declare no conflict of interest.

Translated from the original German by Ralf Thoene, M.D.

Cite this as: Marx C, Thomas D, Sinning JM: Incidental finding of coronary artery aneurysm in a patient with unexplained back and shoulder pain. Dtsch Arztebl Int 2023; 120: 548. DOI: 10.3238/arztebl.m2023.0259