Rapidly Growing Coronary Aneurysm Following Purulent Pericarditis

Pericardiocentesis is associated with occasional infectious complications. Infected coronary artery aneurysms are rare and develop in patients undergoing coronary angiography. We describe a case of a 68-year-old man with prior myocardial infarction who presented with shortness of breath and chest pain 2 weeks after upper respiratory infection. After further workup revealed moderate pericardial effusion, the patient underwent pericardiocentesis and coronary angiography, which revealed multivessel coronary artery disease. The patient was transferred for elective surgical revascularization, which revealed a thickened pericardium with purulent pericardial fluid, suggestive of effusive constrictive pericarditis. Due to the risk for infectious complications, percutaneous coronary intervention was planned after antibiotic treatment. Repeat angiography revealed a coronary artery aneurysm in the proximal left anterior descending and diagonal 1 branch bifurcation, which was closed using an Mguard stent (Inspire MD) with an integrated polyethylene terephthalate net. Complete obliteration of the aneurysm was obtained using this approach.