case_images: PMC11799936_01
case_images: (A) Coronary angiogram demonstrated pooling of contrast adjacent to the right coronary cusp (arrow), indicating a dissection/aneurysm. (B-D) Computed tomogram aortogram showed a 50 x 67 x 76 mm large aneurysmal dilatation from the right aortic sinus, representing a right sinus of Valsalva aneurysm (dotted red, outer line). Heterogenous contrast mixing within the structure represents probable thrombi (dotted blue, inner line). (E and F) Transverse slices of the CT chest demonstrating the presence of the right coronary artery ostium, with its eventual occlusion due to probable thrombus or compression by the aneurysm (arrows).
case_images: ytaf042f1.jpg
case_images: PMC11799936_01_ytaf042f1.jpg
case_images: ytaf042-F1
case_images: A 77-year-old male presented with chest pain and an electrocardiogram showing an inferior ST elevation myocardial infarction (see Supplementary material online, Figure S1). During coronary angiography, pooling of contrast adjacent to the right coronary cusp was detected with no flow down the right coronary artery (RCA), indicative of dissection or aneurysm (Figure 1A, Supplementary material online, Video S1). Mixed density within the aneurysm suggested acute thrombus formation, with migration of the thrombus into the RCA as the cause of the patient's initial presentation (Figure 1B-F).