A Giant Infected Coronary Artery Aneurysm.

A 77-year-old man was admitted to our hospital with femorofemoral bypass graft infection with methicillin-resistant Staphylococcus aureus bacteremia. Following removal of the infected graft, intravenous vancomycin was administered. He became febrile again 19 days after surgery. Contrast-enhanced computed tomography (CT) showed a giant saccular aneurysm (10.5×6.2×6.5 cm) with luminal thrombus (Picture 1). A smaller version of the same aneurysm (2.7×2.9×3.0 cm) was later observed on contrast-enhanced CT performed at admission. Coronary angiography showed that the right coronary artery opened into a large, spherical cavity (Picture 2). An infected coronary artery aneurysm (ICAA) (Picture 3a) filled with white (Picture 3b) and red thrombus (Picture 3c) was then surgically resected, and coronary artery bypass grafting was performed. After six weeks of postoperative intravenous vancomycin treatment, the patient was discharged. Atherosclerosis is a reported risk factor of ICAA, and the superimposed inflammatory process can induce an aneurysm (1). ICAA is often large, averaging 3.4 cm in diameter (2). The present case resulted from systematic infection secondary to severe atherosclerosis and is, to our knowledge, the largest ICAA reported thus far.

Picture 1.

Picture 2.

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The authors state that they have no Conflict of Interest (COI).