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Two Giant Right Coronary Artery Aneurysms with Fistula to the Left Ventricle: Preliminary Diagnosis by Echocardiography

A 51-year-old man was referred to our hospital with a cough productive of white sputum for two weeks. On auscultation, a grade 3/6 diastolic murmur was detected at the apex of heart. Transthoracic echocardiography showed that a giant right coronary artery (RCA) aneurysm, approximately 12 9 11 cm in size, compressing the right atrium and right ventricle, was found in the proximal portion of the vessel (Fig. 1A–C). Another giant RCA aneurysm, approximately 5 9 4 cm in size, was identified in the distal portion of the vessel (Fig. 1D–E). There was a 1.8-cm fistula between the distal part of the RCA and the basal inferolateral wall of the left ventricle (LV) (Fig. 1E). Color Doppler imaging revealed abnormal turbulent flow originating just beneath the