Differential Diagnosis for Aneurysmal Left Main, LAD, and LCx with Mid LAD 30% Lesion and Mild Luminal Irregularities in RCA and LCx
- Single Most Likely Diagnosis
- Atherosclerotic coronary artery disease: This is the most likely diagnosis given the presence of aneurysmal dilatations in the left main, LAD, and LCx, along with a significant lesion in the mid LAD and mild luminal irregularities in the RCA and LCx, which are all indicative of atherosclerotic changes.
- Other Likely Diagnoses
- Kawasaki disease: Although less common in adults, Kawasaki disease can cause coronary artery aneurysms and should be considered, especially if there's a history suggestive of the disease.
- Coronary artery ectasia: This condition involves the dilatation of coronary arteries and can be associated with atherosclerosis or other conditions, presenting similarly to aneurysmal disease.
- Do Not Miss Diagnoses
- Coronary artery dissection: This is a critical diagnosis to consider, as it can present with aneurysmal appearance on imaging and requires urgent intervention to prevent further complications or death.
- Vasculitis (e.g., Takayasu arteritis, giant cell arteritis): These conditions can cause aneurysmal dilatation and stenosis of the coronary arteries and are crucial to diagnose due to their potential for severe complications.
- Rare Diagnoses
- Congenital coronary artery aneurysms: These are rare and usually present in childhood, but can be considered in the differential diagnosis of aneurysmal coronary disease without a clear atherosclerotic or inflammatory cause.
- Infectious causes (e.g., mycotic aneurysms): Although rare, mycotic aneurysms due to infectious agents can cause aneurysmal dilatation of the coronary arteries and should be considered in the appropriate clinical context, such as endocarditis or immunocompromised states.
- Connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos syndrome): These conditions can affect the vascular system, including the coronary arteries, leading to aneurysmal formation, and should be considered in patients with a relevant family or personal history.