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JAMA Cardiology Clinical Challenge
December 19, 2018

A Patient With Multiple Coronary Artery Aneurysms

Author Affiliations
  • 1Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
JAMA Cardiol. Published online December 19, 2018. doi:10.1001/jamacardio.2018.4268

A man in his early 40s was admitted to the hospital because of acute chest pain. Laboratory test results were notable for high serum concentrations of IgG4 (5650 mg/dL; to convert to grams per liter, multiply by 0.01) and C-reactive protein (78.1 mg/L; to convert to nanomoles per liter, multiply by 9.524). Coronary computed tomographic angiography was performed (Figure, A and B). It revealed a large aneurysm (90 mm × 48 mm) with a thrombosis in the left anterior descending artery (LAD) and a perivascular soft-tissue mass involving the patent proximal right coronary artery (RCA) and left circumflex artery, which showed homogeneous moderate enhancement on contrast-enhanced images. Coronary computed tomographic angiography with cinematic rendering (Figure, C) showed multiple mass lesions around the RCA and LAD. Invasive coronary angiography results were unable to visualize the LAD but did identify a hypervascular mass in the proximal RCA.