Aim

Sudden cardiac death or events due to dissection or rupture of aorta, pulmonary or coronary artery is not very uncommon in the young subjects. Echocardiography is critically essential in young subjects who are candidates for the professional sport training. Although the Chest trauma, sport activities, inflammatory diseases (e.g. Takayasu, Kawasaki diseases) genetically inherited disease (Marfan or Ehlers-Danlos Syndrome) are the foremost causes of the dissection of great arteries, sporadic cases with the aneurysm of triple vital arteries, ascending aorta, pulmonary artery and right coronary artery had been very rarely reported.

We aimed to present a very rare co-existence of those arteries and diagnosis of it initially by transthoracic echocardiography and subsequently MSCT angiography.

Case

He was a 19 years old male. His physical examination was completely normal. Cardiac auscultation was normal. Electrocardiogram was normal. Transthoracic echocardiography revealed that aortic sinus and tubular segments were dilated with diameters of 39 mm and 41 mm, respectively (Figure 1). An image of a nidus or indentation was remarkable on the anterior wall of sinotubular segment of aorta. Localization was compatible with the origin of the coronary arteries. Short axis imaging at the level of aorta and pulmonary artery revealed that root and the initial segment of pulmonary artery root was dilated and had a diameter of 35 mm. Then the patient was performed a multi-detector computed tomography coronary angiography. There was a conic aneurysm at the proximal segment (13 mm) of right coronary artery. Diameters of the conic aneurysm were 15 mm at the coronary orifice and 6.5 mm at the end of the conic segment (Figure 2). Following segments of RCA had a 3 mm diameter. LAD and Cx coronary arteries had a normal anatomy.