Man in his third decade with a giant coronary artery aneurysm

This case report details a rare instance of chronic rupture in a 27-year-old male with a giant coronary artery aneurysm (GCAA) in the mid-left anterior descending artery (mid-LAD). Presenting with 4-month chronic chest pain and 3-day hemoptysis, cardiac computed tomography angiography (CTA) and catheter angiography revealed a 3.8 cm × 2.5 cm aneurysm with adjacent 60% stenosis. Etiological workup excluded Kawasaki disease, infective endocarditis, vasculitis, and hereditary vasculopathies via negative serological, infectious, and genetic screening, suggesting an idiopathic origin with chronic inflammatory changes. Surgical management involved coronary artery bypass grafting (CABG) with saphenous vein and aneurysm resection, with no stent implantation attempted. The patient showed favorable recovery with 3-month postoperative follow-up, free of complications. This case highlights the diagnostic value of multi-modality imaging and surgical intervention in young patients with complex aneurysmal pathology.