2022 Volume 86 Issue 5 Pages 881-
A 54-year-old woman who was diagnosed with mixed connective tissue disease (MCTD) was referred to hospital with exertional chest pain. She had no history of Kawasaki disease. Plain chest computed tomography (CT) performed as a screening test uncovered an abnormal mass adjacent to the heart (Figure A). Closer examination with cardiac CT revealed that the mass was a huge coronary artery aneurysm (CAA), located in the right coronary artery (RCA) (Figure B). The CAA was confirmed with coronary angiography (Figure C). Furthermore, myocardial scintigraphy demonstrated myocardial ischemia in the RCA territory. Therefore, we diagnosed the huge CAA as the cause of the exertional chest pain. Coronary artery bypass grafting and resection of the aneurysm were subsequently performed (Figure D). Pathological examinations of the resected CAA uncovered many thrombi within the coronary vessel wall (Figure E,F). The patient was discharged from hospital free from chest symptoms.
(A) Chest CT shows an abnormal mass adjacent to the heart (*). (B) Cardiac CT demonstrates a huge coronary artery aneurysm in the RCA (arrowheads). (C) Coronary angiography confirms the coronary artery aneurysm (arrow). (D) Intraoperative findings of the aneurysm. (E) Gross pathological findings. (F) Pathological examination confirmed the many mural thrombi. CT, computed tomography; RCA, right coronary artery.
MCTD is a systemic collagen disease characterized by coinciding features of systemic lupus erythematosus, systemic sclerosis, and polymyositis/dermatomyositis. Patients diagnosed with MCTD, as well as with other collagen diseases, may experience cardiovascular complications. We present a huge CAA as a cardiovascular complication seen in a MCTD patient. The presence of CAA should be noted as possible for patients with collagen diseases such as MCTD.
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