0:01

So this is an interesting case in that, uh, there

0:04

is a non stenotic atherosclerotic abnormality,

0:10

and what I'll direct your attention

0:11

to is the right coronary artery.

0:14

Uh, and what I'm hoping you noticed when you reviewed is

0:18

that the vessel is very large compared to the remainder.

0:21

In fact, I'm just gonna turn on this maximum intensity

0:23

projection image and just give you a bit of a long axis view

0:27

of the RCA, just to kind of cement the point.

0:31

And when I do that, it's a nice way to kind

0:34

of look in this long axis here, make the C view.

0:37

Uh, but you know, we talked about the definition

0:40

of the reference segment versus the standard anatomy,

0:44

and in this case, there's a more than 50% dilatation of

0:49

what the right coronary artery ought to be.

0:51

And what we have here is an aneurysm of the native, uh,

0:55

right coronary artery.

0:57

Um, and it's also a nice, uh, question for board examiners

1:00

because if I asked you worldwide,

1:02

what's the most common cause of a coronary aneurysm, um,

1:06

worldwide, you would say it's Kawasaki disease,

1:08

which is an infectious cause.

1:10

But in the western and developed world, the

1:13

most common cause of coronary aneurysms is atherosclerosis.

1:18

So in this case, you have a very abnormal vessel,

1:20

um, and contacts matter.

1:22

So if you told me the patient was, um,

1:24

from a less developed country

1:25

and had a lot of extensive

1:28

aneurysms throughout their coronary arteries,

1:30

then you might choose to ask for more history

1:33

that they might have had childhood Kawasaki disease, so a,

1:36

an infectious inflammatory milieu.

1:38

Whereas in the developed world, we're gonna know

1:41

that the most common cause of aneurysms,

1:43

even in the coronary artery is, is uh,

1:45

atherosclerotic degenerative changes.

1:48

So, nice case of an aneurysm.

1:49

And remember that it would be undersized in large part in an

1:53

invasive angiogram because they would only see the lumen,

1:55

whereas you, the CT imager can see it's almost twice

1:58

as large as the lumen when you can consider the wall.

2:01

So, nice case.