Usefulness of cardio MRI on thrombosis of coronary aneurysm as an infrequent cause of ST-elevation coronary syndrome.

ABSTRACT

We present an unusual case of thrombosis of coronary aneurysm causing myocardial infarction with ST-elevation in precordial leads. Emergent coronary angiography showed thrombotic occlusion of an aneurysm in the proximal segment of the left anterior descendent coronary artery (LAD). After the administration of tenecteplase, pain and ST-elevation disappeared with no overt complications. Cardiac magnetic resonance imaging (MRI) performed two weeks after admission showed thrombi partially filling the aneurysm together with further information regarding coronary anatomy, as well as a preserved global function even though delayed enhancement of the myocardium was patent throughout the territory irrigated by LAD. This case supports cardio MR usefulness in Kawasaki disease in order not only to depict coronary abnormalities, but also to provide accurate information regarding function and viability in a non-invasive way. It also highlighted the relevance of a proper selection of the sequence technique when thrombus is suspected. All these advantages point out to cardiac MRI as the modality of choice in the follow-up of patients in this clinical scenario.