A 40-year-old male patient was admitted to a private hospital (Ortadoğu Hastanesi) with complaints of back pain and burning in the stomach for the last 6 months. His hematological examination and echocardiography findings were normal. Chest radiography revealed a bulge on the right side of the heart (Fig. 1). Computed tomography (CT) revealed a homogenously enhanced cystic mass with a maximum diameter of 9 cm, which was adjacent to the aortic root and compressing over the superior vena cava, right atrium, and right ventricle (Fig. 2). CT findings were supported by echocardiography findings (Video 1).
Figure 1.
Chest radiography revealed a bulge on the right side of the heart.
Figure 2.
Computed tomography showed a cystic mass with a maximum diameter of 9 cm, which was adjacent to the aortic root and compressing over the superior vena cava, right atrium, and right ventricle.
Coronary angiography was performed for differential diagnosis; it revealed an aneurysmal sac filling with radiopaque material on the trace of the right coronary artery, indicating communication with the ascending aorta, and distal branches of the right coronary artery filling in the late phase of angiography; however, the left main coronary artery and its branches appeared normal.
Based on CT scan, echocardiography, and coronary angiography findings, differential diagnoses of sinus Valsalva aneu-rysm, aortic pseudoaneurysm, and right coronary artery aneu-rysm were made. The patient was admitted to our clinic and underwent urgent open-heart surgery for these preliminary diagnoses. After opening the mass, we observed a giant aneurysm arising from the proximal portion of the right coronary artery, and the inside of the pouch was covered with a thrombus (Video 2). Right coronary artery continuation was achieved with saphenous vein bypass after resecting the aneurysm. Pathological examination confirmed atherosclerotic aneurysm. The patient was discharged on the fifth day postoperatively.
Video 1
Transthoracic echocardiography demonstrated a 9-cm giant cystic mass adjacent to the lateral wall of the right heart.
Video 2
A giant aneurysm arising from the proximal portion of the right coronary artery can be observed, and the inside of the pouch was covered with a thrombus.
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