Atypical Presentation of Mycotic Coronary Artery Aneurysm

BACKGROUND: Mycotic coronary artery aneurysms (MCAAs) are extremely rare, constituting only 3% of all coronary aneurysms. They most often occur because of infective endocarditis or coronary stents, in particular drug-eluting stents. CASE SUMMARY: We report an unusual presentation of an MCAA presenting as a mediastinal mass after percutaneous coronary intervention (PCI). DISCUSSION: MCAA is an unusual yet potentially fatal complication of PCI with diagnostic difficulty that requires multimodal imaging. Although resection and revascularization are the optimal therapy, covered stenting is an alternative for less invasive intervention. Prompt diagnosis and intervention are key to better outcomes. TAKE-HOME MESSAGES: Although PCI is routine, there is a risk of bacteremia and associated complications such as MCAA. Close attention, early detection, and treatment are important for optimal results.