Aneurysms of the sinus of Valsalva often remain undiagnosed until they rupt
ure. A 61-year-old man had a huge, heavily calcified unruptured aneurysm, o
riginating from the right sinus of Valsalva, detected incidentally on a che
st radiograph taken for the diagnosis of cardiomegaly. Two-dimensional echo
cardiography revealed pericardial effusion with a huge calcified mass compr
essing the right ventricular outflow tract. The Doppler color-how echocardi
ogram showed blood flow from the aortic root into the aneurysm. A chest com
puted tomographic scan revealed a large thrombosed aneurysm originating fro
m the aortic root and measuring 10x10 cm. After pericardiocentesis, cardiac
catheterization was performed, which showed that the right ventricular sys
tolic pressure had elevated to 80 mmHg. Aortic root aortography demonstrate
d a huge unruptured calcified aneurysm in the sinus of Valsalva arising fro
m the right coronary sinus. The patient underwent surgical correction to pr
event aneurysmal rupture and to relieve the right ventricular outflow obstr
uction.