Figure 1. Schematic illustration of coronary aneurysm and ectasia

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Presentation transcript:

Figure 1. Schematic illustration of coronary aneurysm and ectasia

Fig 2 Figure 2. 6-year-old girl with Kawasaki disease presenting with non-thrombosed coronary aneurysm 3D volume rendering CT image shows fusiform aneurysm at the right coronary artery and the left anterior descending artery. Curved multiplanar reformation (cMPR) image shows non-thrombosed fusiform aneurysm at the proximal segment of the right coronary artery.

Fig 3 Figure 3. 3-year-old girl with Kawasaki disease presenting with thrombosed coronary aneurysm 3D volume rendering CT image shows long segmental fusiform aneurysm at the right coronary artery. On curved multiplanar reformation (cMPR) image, partial mural thrombus (arrows) was seen at the peripheral portion of huge fusiform aneurysm involving the proximal to mid segment of the right coronary artery. Actual diameter of aneurysm is much larger than that seen on 3D volume rendering image.

Fig 4 Figure 4. 49-year-old woman with active stage of Takayasu arteritis Transaxial contrast-enhanced CT image shows concentric wall thickening at the right brachiocephalic and the left subclavian arteries. Transaxial contrast-enhanced CT image shows typical “double-ring”sign with poorly enhanced inner ring and well-enhanced outer ring at the ascending and descending thoracic aorta.

Fig 5 Figure 5. 29-year-old woman with Takayasu arteritis involving the right coronary artery ostium.(Courtesy of Dong Hyun Yang, Asan Medical Center) Oblique sagittal multiplanar reformation image shows diffuse wall thickening at the aortic arch and its branches. Transaxial (B) and curved multiplanar reformation (C) images clearly demonstrate the tight luminal narrowing at the ostium of the right coronary artery by extension of inflammation presenting as wall thickening of the ascending aorta into the right coronary artery. Invasive coronary angiogram shows same feature of luminal stenosis at the ostium of the right coronary artery. (QR code) The patient underwent subsequently stent implantation in the right coronary artery. Curved multiplanar reformation image shows excellent luminal patency of stent implanted in the right coronary artery.

Fig 6 Figure 6. 55-year-old woman with Takayasu arteritis Maximum intensity projection (MIP) image shows segmental total occlusion involving the left subclavian artery (arrowhead) and the right axillary artery (arrow). Three dimensional volume rendering image shows focal out-pouching bizarre aneurysm with ring calcification at the right aortic sinus, indicating unusual manifestation of Takayasu arteritis. The right coronary artery ostium was occluded and diffuse narrowing of proximal segment was seen. Curved multiplanar reformation (cMPR) image also shows the occluded right coronary artery proximal segment (arrow).

Fig 7 Figure 7. 22-year-old woman with systemic lupus erythematosus A, B. Three dimensional volume rendering images show diffuse dilatation (ectasia) with combined stenosis of the right coronary artery and the posterolateral branch. C. Curved multiplanar reformation image shows focal wall thickening (arrowhead) at the site of luminal narrowing of the posterolateral branch. D, E. Upper extremity angiograms show diffuse aneurysmal dilatation (ectasia) with multifocal combined stenosis of the brachial artery and its branches. The angiogram features look like “string of beads” appearance similar to fibromuscular dysplasia.

Fig 8 Figure 8. Representative examples of Marfan syndrome B. Three dimenstional volumen rendering (A) and oblique coronal multiplanar reformation (B) images of patient 1 show diffuse aneurysmal dilatation from aortic annulus to ascending aorta indicating annuloaortic ectasia and aortic root aneurysm. C. Two-chamber long axis image of patient 2 shows mitral valve prolapse. D. E. Transaxial images of patient 3 shows multichannel dissecting aneurysm involving the descending thoraic aorta. F. Transaxial image of patient 4 shows abnormal anterior chest wall indentation (pectus excavatum). Chest wall geometry is altered due to scoliosis. G. H. Transaxial images of patient 5 show pectus carinatum, so called “pigeon chest”, and dural ectasia at the level of the sacrum.

Fig 9 Figure 9. 25-year-old man with Marfan syndrome. The patient had a history of Bentall operation due to aortic root aneurysm. Both coronary arteries were reimplanted using button-technique. A,B. Three dimensional volume rendering (A) and curved multiplana reformation (B) images show fusiform aneurysms at the ostiia and the proximal segments of both coronary arteries. Fig 9

Fig 10 Figure 10. 58-year-old woman with cardiac myxoma-related multiple cerebral and coronary aneurysms. This patent has suffered from repetative episodes of stroke with right-sided hemiplegia and dysarthria for 20 years. (QR code) Four-chamber MR image shows an enlongated mass (arrow) attached to the left atrial septum. The mass was confirmed as myxoma.(movie) B, C. 3D volume rendering images show multiple peripheral fusiform aneurysms of the posterior descending artery (arrow) and the obtuse marginal artery (arrowheads). D. Transverse axial MIP image shows focal myocardial thinning suggestive of myocardial infarction in the corresponding area of obtuse marginal branch aneurysm (arrowhead). E, F. Invasive coronary angiograms confirm the presence and the location of multiple coronary aneurysms (arrows). G, H. Brain time-of-flight MR angiograms show a giant fusiform aneurysm (arrow) of the left distal internal carotid artery. Irregular aneurysms (arrowhead) were present in the peripheral branch of the right middle cerebral artery.

Figure 11. 83-year-old woman with atrial fibrillation and ST-elevated myocardial infarction as a result of embolic occlusion of coronary artery by left atrial appendage thrombus. A, Oblique coronal image shows hypoattenuating thrombus at left atrial appendage (arrow). B, Curved multiplanar reformation image shows total occlusion of the left anterior descending artery by hypoattenuating thrombus with enhanced wall. C. Four-chamber image shows corresponding myocardial hypoenhancement (arrows) in the basal to mid anterior and septal wall, which is compatible with acute myocardial infarction. D, Invasive coronary angiography image confirms focal filling defect (arrows) indicating emboli at the mid left anterior descending artery and the diagonal branch. Fig 11

Fig 12 Figure 12. 61-year-old man with acute chest pain. Resting perfusion MR image shows subendocardial perfusion defect (arrowhead) at mid inferoseptal and inferior wall, indicating the territory of the right coronary artery. Ten-minute delayed MR image using phase sensitive inversion recovery sequence after administration of gadolinium contrast shows subendocardial delayed enhancement at the same area (arrowhead), indicating myocardial infarction Invasive coronary angiography image shows no stenosis at the right coronary artery. Invasive coronary angiography image obtained after intracoronary administration of ergonovine shows provoked high-grade luminal stenosis (arrow) at the distal right coronary artery that was completely relieved by intracoronary administration of nitroglycerin.

Figure 13. 46-year-old man with an iatrogenic coronary artery dissection. The coronary CT angiography after failed percutaneous coronary artery intervention shows coronary artery dissection and a intimal flap in the right coronary artery. The false lumen (arrow) is partly thrombosed. The intimal flap extends to the distal right coronary artery. Fig 13

Fig 14 Figure 14. 66-year-old man with acute myocardial infarction due to extrinsic compression of coronary artery by pseudoaneurysm Transaxial image shows a large pseudoaneurysm with surrounding hematoma at the ascending aorta. This is a contained rupture of the ascending aorta with a large defect at the lateral wall. Transaxial image shows extrinsic compression of the left anterior descending artery and the diagonal branches by surrounding hematoma. Transaxial image shows corresponding myocardial hypoenhancement (arrowheads) at the apical anterior and septal wall of the left ventricle indicating acute myocardial infarction. The patient underwent emergent ascending aorta replacement. Pathologic report revealed aortic rupture caused by a penetrating atherosclerotic ulcer.

Fig 15 Figure 15. 54-year-old man with Behcet’s disease Maximum intensity projection image shows pseudoaneurysm (arrow) involving the posterior wall of the left ventricular outflow tract. Surrounding hematoma is also seen extending to the ascending aorta. Curved multiplanar reformation of the right coronary artery shows focal stenosis (arrowhead) of the proximal segment due to surrounding hematoma. Fig 15

Fig 16 Figure 16. 62-year-old man with acute chest pain. This patient had a history of left pneumonectomy due to squamous cell lung cancer. Oblique transaxial image shows infiltrative and irregular hypoattenuating mass invading to left heart, suggestive of recurred lung cancer. Note that the left circumflex (arrow) artery was entirely encased by the mass. Short axis image clearly shows a thorough encasement of the left anterior descending coronary artery (arrowhead) and the ramus intermedius by recurred lung cancer. (QR code) Invasive coronary angiogram shows long segmental fixed luminal narrowing and irregularity of the left circumflex artery (arrows).