# Giant Right Coronary Artery Aneurysm Incidentally Found During Stroke Evaluation Through Echocardiography

## TL;DR

A rare giant right coronary artery aneurysm was discovered in an elderly man during a stroke evaluation using echocardiography.

## Contribution

Echocardiography is proposed as a novel method for identifying giant coronary artery aneurysms.

## Key findings

- A transesophageal echocardiogram localized a ring-like mass near the tricuspid annulus.
- Cardiac catheterization confirmed aneurysms in multiple coronary arteries, including a very large right coronary artery aneurysm.
- Echocardiography may serve as an alternative to cardiac catheterization for detecting coronary artery aneurysms.

## Abstract

Giant coronary artery aneurysms (CAAs) are rare forms of coronary artery disease. An 82-year-old man presented to the hospital with generalized weakness, arm numbness, and dizziness and was found to have a multi-infarct stroke. A transthoracic echocardiogram was obtained to determine a possible cardiovascular etiology of his stroke. However, it did not reveal thrombi or vegetation; instead, it showed a ring-like structure adjacent to the tricuspid valve that appeared to be a large right atrial cyst. A transesophageal echocardiogram was performed localizing the ring-like mass near the tricuspid annulus. Cardiac catheterization revealed aneurysms of the coronary arteries with complete distal occlusion of the left anterior descending artery (LAD), an aneurysmal left circumflex, and a right coronary artery with a very large aneurysm without signs of thrombus or flow-limiting lesion. CAAs are usually found through cardiac catheterization. Echocardiography may be a novel way of identifying CAAs.