Coronary Artery Aneurysms - Applied Radiology
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A 9-year-old girl with known systemic lupus erythematosus (SLE) presents with increasing chest pain. The pain is pleuritic in nature and a pulmonary etiology is suspected.
An initial non-contrast CT scan of the chest showed no significant findings within the lungs to explain the patient’s symptoms. However, a soft-tissue abnormality containing a thin rim of calcification was identified within the pre-aortic space. This abnormality was indeterminate, but possible etiologies included vascular or lymphatic abnormalities. The next day, an ECG-gated, contrast-enhanced CT of the heart was performed. This image showed focal dilatation of the proximal right coronary artery (RCA), just distal to the origin of the artery corresponding to the soft-tissue abnormality identified on the non-contrast CT scan. The focal dilatation within the proximal right coronary artery contained a small amount of nonocclusive mural thrombus, as well as a thin rim of calcification. A few smaller areas of focal dilatation were identified within the distal right coronary artery. Within the proximal left anterior descending artery, there was a small focal dilation as well as a more fusiform dilation located just distally. She was diagnosed with Multiple coronary artery aneurysms secondary to systemic lupus erythematosus

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