Giant coronary artery aneurysm (CAA) is a rare condition, reportedly seen in 0.02-0.2% of patients undergoing coronary angiography. Asymptomatic in most cases, patients may present with angina pectoris, myocardial infarction, cardiac tamponade or sudden death. Given that the natural history of the CAA is still not predictable, the optimal treatment remains still debatable. In this case report, we present a male patient with a sudden non-exertional dyspnea and angina in a context of obesity, multiple large and medium vessels aneurysms and chronic kidney disease (CKD). A contrast CT detected a giant left anterior descending artery (LAD) CAA measuring 73 mm × 47 mm, apparently compressing the circumflex (CX) and the pulmonary artery (PA). After undergoing a full (etiologic and aneurysm extension) panel of exams, the patient underwent a surgical exclusion of the giant CAA and a coronary artery bypass grafting (CABG) by using the left thoracic mammary artery (LITA). The hospitalization was uneventful, and the patient left the hospital completely asymptomatic. In conclusion, even in cases of giant coronary aneurysms, the treatment is surgical by excluding the aneurismatic sac and performing a surgical revascularization.

Giant coronary artery aneurysm (CAA) is a rare condition, reportedly seen in 0.02-0.2% of patients undergoing coronary angiography. Asymptomatic in most cases, patients may present with angina pectoris, myocardial infarction, cardiac tamponade or sudden death. Given that the natural history of the CAA is still not predictable, the optimal treatment remains still debatable. In this case report, we present a male patient with a sudden non-exertional dyspnea and angina in a context of obesity, multiple large and medium vessels aneurysms and chronic kidney disease (CKD). A contrast CT detected a giant left anterior descending artery (LAD) CAA measuring 73 mm × 47 mm, apparently compressing the circumflex (CX) and the pulmonary artery (PA). After undergoing a full (etiologic and aneurysm extension) panel of exams, the patient underwent a surgical exclusion of the giant CAA and a coronary artery bypass grafting (CABG) by using the left thoracic mammary artery (LITA). The hospitalization was uneventful, and the patient left the hospital completely asymptomatic. In conclusion, even in cases of giant coronary aneurysms, the treatment is surgical by excluding the aneurismatic sac and performing a surgical revascularization.