Cardiac Magnetic Resonance in Association With Coronary CT Angiography in the Assessment of Right Coronary Artery Aneurysm With Atrial Fistula Causing Myocardial Ischemia

Coronary artery aneurysms are uncommon. Atherosclerosis is the primary etiology, and the right coronary artery (RCA) is the most frequently involved. We present a case of a 65-year-old male patient presenting with ischemic symptoms and a giant right coronary artery aneurysm with a fistula to the right atrium. The diagnosis was established using non-invasive imaging modalities, including cardiac magnetic resonance (CMR) and coronary computed tomography angiography (CCTA). This case underscores the critical role of a combined imaging approach in effectively managing such rare and complex coronary artery conditions. The collaboration of CMR, providing data on myocardial viability and thrombus, with CCTA, offering precise anatomical details, enables clinicians to gain a comprehensive understanding of the aneurysm and its complications. This integrated approach guides optimal treatment strategies and ultimately improves patient outcomes.