case_images: PMC10244565_01
case_images: Multimodal imaging. (A) Anteroposterior chest x-ray. (B) Bronchoscopy view at the level of the left lobar bronchus. (C) Coronal view of thoracic MRI. (D) Coronary CT angiography demonstrating LAD with a large aneurysm wrapped in the hematoma (asterisk). (E) Preoperative coronary CT angiography: 3D reconstruction view. (F) Coronary angiography. LAD, left anterior descending artery.
case_images: fcvm-10-1185089-g001.jpg
case_images: PMC10244565_01_fcvm-10-1185089-g001.jpg
case_images: F1
case_images: Chest x-ray (Figure 1A) showed an enlarged left cardiac silhouette with a conspicuous bulge encroaching on the left upper-middle lung field. In addition, bronchoscopy (Figure 1B) detected fresh blood in the left upper lobe bronchus, however, the definitive bleeding source was not identified. MRI with a T1W1 sequence (Figure 1C) demonstrated that the heterogeneous mass was essentially caused by active bleeding, and the possible diagnosis of a mediastinal tumor was excluded. Meanwhile, coronary CT angiography (Figures 1D,E) revealed a giant suspicious left coronary artery aneurysm (37 mm x 23 mm) wrapped in a large mediastinal mass (103 mm x 75 mm), which extended to the left chest wall and infiltrated the lung lobe. Furthermore, coronary angiography (Figure 1F; Supplementary Video S1) confirmed a saccular CAA originating from the middle portion of the left anterior descending artery.
case_images: Intraoperative findings and postoperative images. (A) Ruptured CAA. (B) Coronary artery bypass surgery. (C) Postoperative coronary CT angiography: 3D reconstruction view. SVG, saphenous vein graft; AO, aorta; PA, pulmonary artery; RCA, right coronary artery; LCX, left circumflex artery; LAD, left anterior descending artery.
case_images: fcvm-10-1185089-g002.jpg
case_images: PMC10244565_01_fcvm-10-1185089-g002.jpg
case_images: F2
case_images: After the removal of the limited thrombi eroding the left pleura densely and adhering to the left upper lung, a large pseudoaneurysm arising from a ruptured left CAA was identified (Figure 2A; Supplementary Video S2). The aneurysmal sac was resected, and a saphenous vein graft was used to bypass the distal left anterior descending artery (Figure 2B). The patient recovered uneventfully with cessation of hemoptysis, and predischarge CTA 9 days after surgery showed the disappearance of the left CAA (Figure 2C).