What is the abnormality noted on coronary angiography in a patient presenting with chest pain? An adult woman with systemic lupus erythematosus, hypertension, and end-stage kidney disease presented with bacteremia and chest pain. Transthoracic echocardiogram showed a right atrial mass. Coronary computed tomography angiography revealed a right coronary artery (RCA) aneurysm at the acute margin of the right ventricle.¹ Fluorodeoxyglucose positron emission tomography did not find an infection site in the RCA region. Following treatment of bacteremia, the patient underwent catheterization of the left side of the heart that showed a very large-caliber RCA with a large (5-cm) spherical aneurysm in the distal vessel with TIMI I flow beyond (Figure, A). Endovascular coil embolization of the aneurysm was performed using 2 framing and 2 filling coils, and then 2 overlapping Graftmaster (Abbott Vascular Inc) covered stents (4.8 × 16 mm) were deployed in the RCA resulting in significant improvement of distal flow (Figure, B).² The patient remained stable and asymptomatic and was discharged home.

胸痛患者的冠状动脉造影发现什么异常？一名患有系统性红斑狼疮、高血压和终末期肾病的成年女性出现菌血症和胸痛。经胸超声心动图显示右心房肿块。冠状动脉计算机断层扫描血管造影显示右心室急性边缘的右冠状动脉 (RCA) 动脉瘤。¹氟脱氧葡萄糖正电子发射断层扫描在 RCA 区域未发现感染部位。菌血症治疗后，患者接受了心脏左侧的导管插入术，结果显示一个非常大口径的 RCA，远端血管中有一个大（5 厘米）球形动脉瘤，TIMI I 流出（图，A）。使用 2 个框架和 2 个填充线圈进行动脉瘤的血管内线圈栓塞，然后在 RCA 中部署 2 个重叠的 Graftmaster (Abbott Vascular Inc) 覆膜支架 (4.8 × 16 mm)，从而显着改善远端血流（图 B ）。²患者病情稳定，无症状，出院回家。