Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 2 2023 04 30 142 145 Usha Kumari Dow University of Health Sciences, Karachi, Pakistan. Mansoor Rahman Postgraduate Trainee Cardiology, Lady Reading Hospital, Peshawar. Muneeb Ullah Jan Department of Cardiology, Lady Reading Hospital, Peshawar Pakistan Salecah Rahmat  Ullah 1. Central Michigan University Hospital Saginaw, USA. 2. Khawaja Safdar Medical College Sialkot, Pakistan Fakhar Abbas King Edward Medical University, Lahore, Pakistan. Zara Mirza Senior Resident, Cardiac Surgery, National Institute of Cardiovascular Disorders, Pakistan. Salim Surani Adj. Clinical Professor of Medicine and Pharmacology, Texas A&M University 2023 01 08 2023 04 30 Coronary artery aneurysms (CAAs) occur when an artery dilates 1.5 times the reference vessel. They occur most commonly because of atherosclerosis. CAAs are a rare phenomenon, and it is even rarer to find a giant CAA, which is roughly defined as a size 400% above the reference vessel. Giant CAAs are commonly found in the right coronary artery. The sinoatrial nodal artery (SNA) is among the least common sites for CAA involvement. Sometimes, communication exists between the aneurysm and a chamber of the heart or a great vessel. The consequences of the fistula depend on its size. Because of the rarity of the condition, guidelines are not well developed. However, small CAAs can be managed conservatively, whereas giant CAAs require resection, ligation, and bypass grafting. CAAs have a predilection for males and the elderly. We describe a 40-year-old South Asian woman presenting with mild dyspnea on exertion of 1 year’s duration. Echocardiography showed a 60×60 mm cystic sac, subsequently confirmed by computerized tomography, which showed 3 large aneurysms (70×61 mm) and 3 small aneurysms in the SNA. Coronary angiography illustrated that the SNA branched off the left main coronary artery, and the aneurysm communicated with the right coronary artery. The aneurysm was partially resected and plicated. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1788 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1788/1068