Coronary artery aneurysms are exceedingly rare and tend to be found
incidentally on angiography. We present the case of a 6cm giant coronary
artery aneurysm discovered in a 25 year old man. Subsequent workup
included cardiac gated MRI, CT angiography and left heart
catheterization. Imaging revealed a 6.7 x 6.2 x 6.0 cm aneurysm
involving the mid LAD subsequent to the takeoff of a large septal
perforator. He was taken electively for operative repair during which
the aneurysm was opened, unroofed and ligated at the ostium while taking
care to ensuring normal flow in the septal perforator that supplied
multiple small collaterals. In this unique case, a coronary artery
aneurysm of considerable size was encountered in the LAD of a healthy
young adult in which the size of the aneurysm precluded distal
revascularization via bypass grafting. Multiple imaging modalities were
used to characterize this finding and aid in surgical planning.