The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Chana A. Sacks, M.D., Editor

Left Main Coronary Artery Aneurysm

A 
Luis Arboine, M.D. 49-year-old man with hypertension was referred to our hospi-
Juan M. Palacios, M.D. tal for recurrent angina after receiving recombinant tissue plasminogen
Hospital de Enfermedades activator for acute ST-segment elevation myocardial infarction. His blood
  Cardiovasculares y del Torax pressure was 113/68 mm Hg, and his heart rate was 110 beats per minute. An
Monterrey, Mexico electrocardiogram showed a right bundle-branch block and ST-segment elevation
luisarboine1986@​­gmail​.­com
in the anterolateral leads. The troponin I level was 164 ng per deciliter (normal
level, <0.04). Coronary angiography was performed. The left main coronary artery
opened into a large spherical cavity — an aneurysm that measured 69 by 53 mm
— that filled with contrast material in a swirling fashion, with slow opacification
A video showing of the left anterior descending and circumflex arteries (see video). Causes of coro-
the coronary nary artery aneurysms include atherosclerosis, vasculitides, connective-tissue dis-
artery aneurysm
orders, congenital defects, infections, and complications of percutaneous coronary
is available at
NEJM.org intervention. The patient underwent urgent surgery, but the postoperative course
was complicated by cardiogenic shock, and he died the day after surgery.
DOI: 10.1056/NEJMicm1708877
Copyright © 2018 Massachusetts Medical Society.

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