A Surgical Case of Expanding Bilateral Coronary Aneurysms Regarded as Immunoglobulin G4-Related Disease

A 69-year–old man was referred to our department for surgical treatment of bilateral giant coronary artery aneurysms. He had no apparent clinical factors associated with atherosclerosis, such as diabetes mellitus, hyperlipidemia, or hypertension. Physical examination revealed no abnormalities. His medical history included malignant lymphoma that had been treated with chemotherapy and radiation therapy at the age of 60 years. He was also diagnosed with a plasma cell tumor in his tonsils at the age of 68 years. Just before treatment for this tumor, he developed sudden-onset myocardial infarction. Coronary angiography revealed 2 giant coronary aneurysms; one presented as a broad aneurysmal change of the right coronary artery (Figure 1A and Movie I in the online-only Data Supplement), and the other was located from the left main coronary artery to the left anterior descending artery (Figure 1B and Movie II in the online-only Data Supplement). On the basis of subsequent computed tomography, the maximum diameters of the right and left coronary aneurysms were 40 and 25 mm, respectively (Figure 2). Laboratory examination showed that the serum immunoglobulin …