Giant coronary artery aneurysm presenting as a mediastinal mass

In older patients, most coronary artery aneurysms are due to atherosclerosis. The presence of diffuse atheroma within the aneurysm and throughout the left coronary artery makes this etiology most likely in this case. Most atheromatous aneurysms are small; this is the largest atheromatous coronary artery aneurysm ever reported.2,6–8 Although this aneurysm was asymptomatic, surgical excision and repair was indicated because of the high risk of rupture of an aneurysm of the size.1,2