Circumflex coronary artery aneurysm visualized by real-time cross-sectional echocardiography. A possible sequelae of previously unrecognized coronary arteritis in the adult.

Real-time cross-sectional echocardiography disclosed an aneurysm of the circumflex branch of the left coronary artery in an asymptomatic 30-year-old man. Plain chest roentgenogram showed an abnormal silhouette along his left heart border. He also was found to have an abnormal contraction pattern of the posterolateral wall of the left ventricle and a reduced left ventricular ejection fraction. Left ventricular and coronary angiography showed a similar impairment in left ventricular function and occlusion of the circumflex branch of the left coronary artery. Surgery and pathologic examination confirmed the presence of the aneurysm. The echocardiographic characteristics of this lesion and the left ventricular contraction abnormalities suggest the possibility that it resulted from a remote episode of coronary arteritis. Real-time cross-sectional echocardiography, by virtue of its ability to provide visualization of structures along the posterior border of the heart as well as information about regional wall motion, may be of considerable value in localizing and defining lesions occurring in this area.