Jan Nemec, MD, Kirk N. Garratt, MD, Hartzell V

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Asymptomatic Occlusion of the Left Main Coronary Artery by an Aortic Pseudoaneurysm Jan Nemec, MD, Kirk N. Garratt, MD, Hartzell V. Schaff, MD, Mark Goodwin, MD, Dwight Morrow, MD, Alan Brown, MD, Bijoy K. Khandheria, MD Mayo Clinic Proceedings Volume 75, Issue 11, Pages 1205-1208 (November 2000) DOI: 10.4065/75.11.1205 Copyright © 2000 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 Lateral chest radiograph shows a partially calcified mass (arrowheads) close to the aortic root. It projected over the left pulmonary hilum on a posteroanterior projection. Mayo Clinic Proceedings 2000 75, 1205-1208DOI: (10.4065/75.11.1205) Copyright © 2000 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 A, Attempted injection of the left main coronary artery in a left anterior oblique projection resulted in opacification of the pseudoaneurysm, which was partially filled with thrombus. Note the thin shell of calcification in the wall of the large pseudoaneurysm (arrowheads). B, Contrast injection of the right coronary artery in a left anterior oblique projection shows extensive retrograde filling of the territory of the circumflex and left anterior descending arteries through rich collateral vessels. C. Contrast injection of the ascending aorta in a left anterior oblique projection. The neck (arrow) of the pseudoaneurysm can be clearly appreciated. Mayo Clinic Proceedings 2000 75, 1205-1208DOI: (10.4065/75.11.1205) Copyright © 2000 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 3 Transverse magnetic resonance image of the chest at the level of the pseudoaneurysm. A large thrombus (T) fills most of the pseudoaneurysm, which communicates with the ascending aorta (A) and abuts the pulmonary artery (P). Mayo Clinic Proceedings 2000 75, 1205-1208DOI: (10.4065/75.11.1205) Copyright © 2000 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 4 Excision of the portion of the aortic wall containing the defect shows a round, smooth opening, inconsistent with a traumatic cause. Mayo Clinic Proceedings 2000 75, 1205-1208DOI: (10.4065/75.11.1205) Copyright © 2000 Mayo Foundation for Medical Education and Research Terms and Conditions