Coronary artery aneurysms involving all the three coronaries: a rare entity.

To cite: Parekh P, Agrawal N, Vinchurkar M, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014204144 DESCRIPTION Coronary artery aneurysm (CAA) is defined as dilation exceeding the reference vessel diameter by 50%, while they are termed giant if their diameter exceeds the reference vessel diameter by four times or if the diameter is more than 8 mm. It is uncommon to see aneurysmal involvement of all the three coronary arteries simultaneously. We present a case of an elderly man who presented with symptoms of class III angina for which he underwent a diagnostic angiogram, which revealed the presence of an atherosclerotic aneurysm involving all the three coronary arteries with one of them being of a giant size of 16× 34 mm. The patient had critical triple vessel disease for which he underwent coronary artery bypass grafting along with ligation and repair of the aneurysm of the left anterior descending (figures 1–3, videos 1–3). Atherosclerosis accounts for the vast majority of CAAs in adults. Other causes include Kawasaki disease, Takayasu’s arteritis, poly arteritis nodosa, lupus erythematosus, connective tissue disorders, congenital defects, infections (such as narcotic emboli, syphilis and Lyme disease), trauma, dissection and cocaine abuse, and may be either iatrogenic or idiopathic. There is no definite recommendation for the appropriate indication and timing of management of atherosclerotic aneurysms of coronary arteries, neither is there a definite modality of choice of treatment although surgical ligation or covered stents have been used in anecdotal cases with a good outcome. Giant aneurysms should be managed aggressively especially when they harbour a thrombus and also when the patient is undergoing any other cardiac surgery as in our case.