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Ann Thorac Surg 2008;85:1812. doi:10.1016/j.athoracsur.2007.07.086
© 2008 The Society of Thoracic Surgeons
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Saina Attaran
Ahmed El-Gamel
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Images in Cardiothoracic Surgery

Use of Three-Dimensional Computed Tomographic Reconstruction in the Diagnosis of a Rare Case of Angina

Saina Attaran, MRCS*, Stam Kapetanakis, MRCP, Peter Mhandu, MRCS, Ahmed El-Gamel, FRCS

Department of Cardiology and Cardiothoracic Surgery, King's College Hospital, London, England

* Address correspondence to Dr Attaran, 46 Queen of Denmark Ct, Finland St, London, SE16 7TB, England (Email: saina.attaran{at}kcl.ac.uk).

A 59-year-old man presented with 15-month history of angina on exertion and one episode of collapse. His angiogram showed mild irregularity in the coronary arteries. Transesophageal echocardiogram was suspicious of a possible mass.

He then underwent a computed tomographic angiogram (Fig 1; [A] axial view, [B] coronal view, [C] sagital view) that demonstrated a soft tissue density posterior and anterior to the ascending aorta (arrows in A, B, C) in the superior pericardial recess, which was possibly an aneurysm with a dissection flap (D in Fig 1A) distal to the origin of the right coronary artery extending superiorly. However, a three-dimensional reconstruction computed tomographic scan (Fig 2) confirmed the presence of an aneurysm (arrows) adjacent to the left coronary artery, which was compressing the left main stem against the pulmonary artery.


Figure 1
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  		Fig 1.
 

Figure 2
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  		Fig 2.
 
He had a median sternotomy that revealed a perforated aneurysm of the left sinus of Valsalva with no dissection. This was closed and was repaired successfully with a pericardial patch. He made a full postoperative recovery.





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Ahmed El-Gamel
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