Coronary artery aneurysms—a truly rare entity or simply unrecognized so far?

Coronary artery dilatations are characterized by an enlarged coronary artery lumen more than 1.5 times the diameter of normal adjacent segments or the diameter of the patient’s largest coronary artery. They are divided into coronary artery ectasia and aneurysms. Coronary ectasias are diffuse and involve 50% or more of the length of the artery, while coronary artery aneurysms (CAAs) are more focal, involving <50% of the total length of the vessel. In children, according to the AHA classification a diagnosis of a CAA is based on a coronary artery Z score ≥2.5. CAAs are characterized as giant when the maximal diameter exceeds 20 mm in adults and 8 mm or a coronary artery Z score ≥10 in children [1, 2]. The biggest CAA described had a maximum diameter of 180 mm [3]