Unruptured multi-compartmental left sinus of Valsalva aneurysm with chronic dissection of inter-atrial septum and left ventricular free wall

The sinus of Valsalva aneurysm (SVA) is a small dilatation caused by a separation between the aortic media and annulus fibrosus. A 30-year-old female presented with complaint of pain abdomen. She was evaluated with CT abdomen, scanogram showed ventricular wall calcifications. There was history of intermittent palpitation and exertional breathlessness. On further evaluation with echocardiogram and 64 slice CT scanner, it turned out to be unruptured aneurysm arising from the left coronary sinus. It is a unique aneurysm, which bifurcated into superior part giving origin to the left coronary artery and inferior part dissecting as a complex multilobated aneurysm. The aneurysm had three components in the groove between left atrium and aortic root, dissecting aneurysm into the inter-atrial septum with thrombus, and dissecting aneurysm into the anterolateral free wall of the left ventricle, protruding into the lumen.