Unusual types of coronary artery lesions
The most common form of coronary artery disease is coronary atherosclerosis, which often produces narrowing of the lumen of epicardial branches of the coronary arteries. However, many other pathological processes may involve the coronary artery, for example, various forms of arteritis, trauma, metabolic causes, congenital abnormalities, thromboembolism, or functional disorders. A few of these subiects will be discussed.
Coronary artery aneurysm
Coronary artery aneurysm was described by pathologists more than 200 years ago. With the advent of coronary arteriography, antemortem diagnosis of coronary aneurysm became possible. The etiology is atherosclerosis in more than half of the cases. Other causes are congenital, mycotic-embolic, dissecting, and syphilis. Trauma and various forms of arteritis, especially the infantile form of polyarteritis nodosa and Kawasaki's disease (MCLNS) are associated with coronary artery aneurysm. The aneurysms have no distinctive clinical features and the major presenting symptoms are angina or myocardial infarction, which are related to embolization of thrombotic material from the aneurysm to the distal artery or thrombosis of the aneurysm and occlusion of the coronary artery. Rupture can occur in polyarteritis nodosa or mycotic aneurysm. It is less common in the congenital form and rarely occurs in atherosclerotic cases.
Ectasia of the coronary artery
Generalized aneurysmal dilatation and irregularity of the coronary artery have been called coronary ectasia. This is a distinct clinical entity, although it is not well studied and its natural history is not well known. Its incidence has been reported to be about 1.2%. Its etiology is atherosclerotic, and the aneurysmal dilatation . . .