Suspected contained rupture of a coronary artery aneurysm followed by a re-rupture: a case report

Background: Most coronary artery aneurysms (CAAs) are clinically asymptomatic and are only detected incidentally during cardiac imaging. However, CAAs can cause fatal complications such as cardiac tamponade following a rupture. Reports of contained ruptures of CAAs are limited.

Case summary: An 89-year-old man had a severe, acute-onset chest pain 2 days prior. The patient was referred to our hospital because of residual dyspnoea and a fever. The blood tests exhibited high C-reactive protein and D-dimer levels; moreover, contrast-enhanced computed tomography (CT) and transthoracic echocardiography revealed a diffuse mild pericardial effusion, which had not been detected six months prior. The fever and pericardial effusion persisted, and the main cause was not clearly understood. On Day 19, the patient had a sudden loss of consciousness after chest pain. Contrast-enhanced CT showed an increase in the pericardial effusion, and coronary angiography showed a CAA in the proximal right coronary artery with extravasations that probably sealed. A re-rupture following a contained rupture of the CAA was considered, and it was suspected that the prolonged fever and pericardial effusion were related to the contained rupture associated with the first episode of chest pain.

Discussion: Our case showed that a contained rupture of a CAA can cause a fatal event by a re-rupture and may present with a prolonged fever and pericardial effusion. A contained rupture of a CAA should be considered as a differential diagnosis in patients with a prolonged fever and pericardial effusion of unknown origin after an acute onset of chest pain.