CTICasesCoronary Artery Aneurysms and Occlusion in Eosinophilic Granulomatosis with Polyangiitis (EGPA) Variant
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Imaging findings
A 38-year-old female with chest pain and non-ST elevation MI showed subtle dilation of the left coronary artery and proximal circumflex on an initial PE protocol CT. A subsequent coronary CTA dramatically revealed multiple coronary artery aneurysms in the LAD, areas of soft tissue within the vessel wall, and complete occlusion of the mid-RCA with distal reconstitution. The patient had a history of eosinophilia and asthma.
Key takeaways
Diffuse coronary artery aneurysms in a young to middle-aged adult, particularly with a history of eosinophilia and asthma, should prompt consideration of vasculitides such as eosinophilic granulomatosis with polyangiitis (EGPA, formerly Churg-Strauss syndrome). EGPA can cause coronary artery aneurysms and occlusion, leading to myocardial infarction, and highlights that conditions other than Kawasaki disease can lead to such findings.
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