Possible Right Coronary Artery Supply to Pericardial Adipose Tissue Adjacent to an Abnormal Proximal Ascending Aortic Wall: A Case Report

A 63-year-old male patient with chronic obstructive pulmonary disease (COPD) was examined using cardiac computed tomography (CT) and transesophageal echocardiography (TEE) to estimate the presence of chronic thrombi, such as left atrial appendage (LAA) thrombi and pulmonary vein thrombi (PVTs). The patient presented with a strange thrombus-containing vessel over the anterior surface of the heart, which did not appear to be a coronary vein. The abnormal wall of the ascending aorta (AAo) was difficult to differentiate from the AAo thrombi, and a dark (low echogenic) mass was observed in the center of the abnormal AAo wall on TEE. The origin of the mass was unknown but could potentially be associated with atherosclerosis, a Valsalva aneurysm, aortic dissection, an aortic aneurysm, or aortic valve disease. The relationship between these factors and the coronary artery, as well as whether apixaban (a factor Xa inhibitor) could cure the cleft in the mass, remains unclear.