Author + information
- Received June 26, 2013
- Revision received August 3, 2013
- Accepted August 13, 2013
- Published online February 10, 2015.
- Ullrich Ebersberger, MD∗,
- Johannes Rieber, MD∗,
- Petra Wellmann, MD†,
- Constanze Goebel, MD‡ and
- Brigitte Gansera, MD†
A 35-year-old Caucasian female with a history of systemic vasculitis and suspicion of polyarteritis nodosa was referred for evaluation of recurrent chest pain. The echocardiogram showed a normal left ventricular ejection fraction and an ambiguous 30-mm-wide hypoechoic structure lateral to the right atrium (Figure 1A). Cardiac catheterization (Figure 1B, Online Video 1) revealed a vast aneurysm of the right coronary artery. Pre-operative computed tomography confirmed the finding of a coronary aneurysm (Figure 1C), and magnetic resonance imaging angiography revealed a second inguinal aneurysm (Figure 1D). Due to the potential inflammatory involvement of the internal thoracic artery, a single coronary artery bypass using a saphenous vein graft was performed without complications. Intraoperatively, thrombotic material was observed within the aneurysm (Figures 2A and 2B). The patient was extubated during the first day. On the second post-operative day, she was transferred in stable condition to the cardiac surgical ward. On histological examination, a hematoxylin and eosin–stained section of the coronary artery aneurysm showed transmural inflammatory necrotic and fibrotic infiltrations consistent with the diagnosis of polyarteritis nodosa (Figures 2C and 2D). Treatment with intravenous cyclophosphamide was initiated, and the patient was discharged in good condition to rehabilitation.
JACC is publishing 3 “Images in Cardiology” articles in this issue. These manuscripts were accepted prior to the current editorial administration. Please note that they are no longer a standard manuscript type that will be acceptable by the Journal.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Ebersberger and Rieber are joint first authors.
- Received June 26, 2013.
- Revision received August 3, 2013.
- Accepted August 13, 2013.
- American College of Cardiology Foundation