# Possible Right Coronary Artery Supply to Pericardial Adipose Tissue Adjacent to an Abnormal Proximal Ascending Aortic Wall: A Case Report

## TL;DR

A 63-year-old COPD patient's imaging revealed a strange vessel near the heart, possibly linked to aortic wall abnormalities and unclear mass origins.

## Contribution

This case report highlights an unusual anatomical and pathological finding involving the aortic wall and coronary artery supply.

## Key findings

- A thrombus-containing vessel was observed over the anterior heart surface, not a coronary vein.
- An abnormal ascending aortic wall showed a dark mass, possibly linked to atherosclerosis or dissection.
- The relationship between the mass, coronary artery, and apixaban's potential effect remains unclear.

## Abstract

A 63-year-old male patient with chronic obstructive pulmonary disease (COPD) was examined using cardiac computed tomography (CT) and transesophageal echocardiography (TEE) to estimate the presence of chronic thrombi, such as left atrial appendage (LAA) thrombi and pulmonary vein thrombi (PVTs). The patient presented with a strange thrombus-containing vessel over the anterior surface of the heart, which did not appear to be a coronary vein. The abnormal wall of the ascending aorta (AAo) was difficult to differentiate from the AAo thrombi, and a dark (low echogenic) mass was observed in the center of the abnormal AAo wall on TEE. The origin of the mass was unknown but could potentially be associated with atherosclerosis, a Valsalva aneurysm, aortic dissection, an aortic aneurysm, or aortic valve disease. The relationship between these factors and the coronary artery, as well as whether apixaban (a factor Xa inhibitor) could cure the cleft in the mass, remains unclear.