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- 저자 : ( Fernando Lozano Ruiz Poveda ) (검색결과 1 건)
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( Yasser Hessen Abdou ),( Maria Angeles Perez Martinez ),( Natalia Pinlla Echevarri ),( Maria Thiscal Lopez Lluva ),( Fernando Lozano Ruiz Poveda ),( Ignacio Sanchez Perez ),( Miguel Angel Rienda More 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
A 36 year-old man was referred to our hospital for the evaluation of an abnormal shadow on the cardiac apex on a chest X-ray fi lm.He denied systemic disease such as hypertension or diabetes mellitus and had no history of specifi c conditions, such as Kawasaki`s disease, chest trauma or connective tissue disorder. He had no subjective symptoms. His blood pressure was 120/75 mmHg and pulse rate was 70 beats/min. On physical examination, continuous murmur of a grade II/VI was audible at 4th left intercostal space. The results of other physical examination and blood test were normal. A Chest X-ray showed a radio-opaque shadow at the apex. An echocardiography was arranged and a round sac of 4x4 cm located in the apex, as well as a double-chamber right ventricle was observed Contrast echocardiography with Sonovue showed the fi lling of the vascular sac with contrast then partial fi lling of the distal RV apex. The abnormal vascular sac was connected from the left side to a vascular structure that looks to be coronary artery and from the right side to the distal part of a double right ventricle apex with a bi-directional shunt (fi stula). It also demonstrates the high velocity and centrifuge nature of blood fl ow in the vascular sac. Chest CT showed a LAD ectasia with a 4x4 cm saccular aneurysm at the distal portion of LAD Cardiac MRI revealed a giant left descending coronary artery distal aneurysm attached to a double apex right ventricle Coronary angiography revealed a dilated LAD with a huge saccular coronary aneurysm at its distal portion. The patient refused surgical correction for the coronary aneurysm and fi stula. He was discharged and has been followed up for more than 1 year without cardiovascular events.
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