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A n 83 year old man presented with shortness of breath. Physical examination revealed a raised jugular venous pressure and atrial fibrillation with a rapid ventricular response. A provisional diagnosis of congestive cardiac failure was made and treatment with digoxin and diuretics initiated. A transthoracic echocardiogram demonstrated a large “doughnut” shaped extracardiac mass compressing and displacing the right atrium.
Non-invasive coronary angiography was performed using multislice helical (“spiral”) computed tomography (CT). The breath hold required for a scan time of 31 seconds was well tolerated. Following contrast injection images were acquired using a gantry rotation time of 500 ms and retrospective electrocardiographic gating. Images were then reconstructed using the diastolic phase. Despite the lack of a regular R–R interval, excellent image resolution was obtained.
Axial transverse reconstruction (multiplanar reconstruction or MPR) CT coronary angiography (upper panel) demonstrated a right coronary artery aneurysm. The right coronary artery is shown arising from the aorta (Ao). The contrast filled lumen (An) of the aneurysmal portion of the artery is surrounded by unenhanced thrombus, which explained the echocardiographic appearances. The aneurysm is compressing the right atrium. A three dimensional reconstruction (using volume rendering techniques or VRT) shows the lumen of the aneurysm (An in lower panel) without the surrounding unenhanced mural thrombus. Although this type of “visual” reconstruction provides excellent information for surgeons, the treatment in this case was medical in view of the patient's frailty and his good response to rate controlling drugs.