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(Circulation. 2000;102:3023.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Granulomatous Aortitis Presenting as an Acute Myocardial Infarction in Crohn’s Disease

Michael H. Goldman, MD; Bechara Akl, MD; Shayryar Mafi, MD; Lucia Pastore, MD

From Fairfax Medical Center, Fairfax, Va.

Correspondence to Michael H. Goldman, MD, 1635 N George Mason Dr, Suite 150, Arlington, VA 22205. E-mail cardiovascularcare@erols.com

A 33-year-old man was admitted emergently with evidence of an acute inferior apical myocardial infarction. He had no previous cardiac history but did have a 20-year history of symptomatic Crohn’s disease. His subsequent coronary angiography revealed a long filling defect in the apical portion of the left anterior descending coronary artery, consistent with intraluminal thrombus (Figure 1). Left ventriculography demonstrated inferior apical akinesia. Visualization of the ascending aorta during ventriculography unexpectedly revealed a filling defect above the aortic valve. Aortography was performed, and it confirmed the presence of an apparently pedunculated mass 4 cm above the valve, with no evidence of aortic insufficiency (Figure 2A).

View larger version (133K): [in this window] [in a new window]   Figure 1. Coronary angiography in right anterior oblique projection reveals a filling defect in apical portion of left anterior descending coronary artery, consistent with a coronary embolus.

View larger version (147K): [in this window] [in a new window]   Figure 2. A, Aortography in left anterior oblique projection reveals a filling defect (arrow) in aorta above aortic valve. B, Transesophageal echocardiography reveals a mobile mass (arrow) attached to anterior surface of aorta. C, MRI reveals small linear defect (arrow). D, CT scan reveals faint linear defect (arrow).

A transesophageal echocardiogram demonstrated a mobile, pedunculated mass attached to the ascending aorta, which was suggestive of an intimal flap and/or possible thrombus. No clear dissection was demonstrated (Figure 2B). MRI (Figure 2C) and CT scans (Figure 2D) demonstrated a "linear defect" consistent with a limited dissection.

At surgical exploration, the outer surface of the aorta appeared normal, without evidence of hematoma, dissection, or enlargement. The aorta was transected. . . . [Full Text of this Article]

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