Rupture of an aneurysm of the coronary sinus of Valsalva: diagnosis by helical CT angiography

A 75-year-old man presented with a 5-day history of upper chest discomfort. On auscultation, there was a systolic murmur in the left parasternal area that radiated to the apex. Electrocardiography showed flat T waves in the a nterior precordial leads. Chest X ray revealed mediastinal enlargement. Tra nsthoracic echocardiography showed a dilated proximal ascending aorta with moderate aortic regurgitation. A contrast-enhanced helical CT scan, perform ed to eliminate an aortic dissection, showed a ruptured left coronary sinus of Valsalva aneurysm, confirmed at surgery. This case highlights the fact that helical CT, in patients with suspected aortic dissection, may reveal o ther pathology that accounts for the clinical presentation.