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Coronary Computed Tomography Angiography of Spontaneous Coronary Artery Dissection: A Case Report and Review of the Literature

Management of emergency care, Rare disease

Stephanie C. Torres-Ayala, Jose Maldonado, J. Scott Bolton, Sanjeev Bhalla

Puerto Rico Department of Diagnostic Radiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico

Am J Case Rep 2015; 16:130-135

DOI: 10.12659/AJCR.892805

Available online: 2015-03-04

Published: 2015-03-04


#892805

Background: Multidetector computed tomography (MDCT) has gained wide acceptance in the evaluation of the cardiovascular system. Of particular clinical interest is its ability to non-invasively evaluate coronary arteries in patients presenting to the emergency room. In acute coronary syndromes, myocardial ischemia is most often caused by atherosclerosis. We present a case of a rare cause of acute coronary syndrome, spontaneous coronary artery dissection (SCAD), which was initially evaluated with MDCT and followed by intravascular ultrasound (IVUS) and invasive coronary angiography (ICA). We discuss the findings and role of each modality with particular attention to coronary computed tomographic angiography (CCTA) in the diagnosis and management of SCAD. As the use of CCTA in the emergency department continues to rise, radiologists must become familiar with CT appearance of SCAD.
Case Report: We report the multidetector computed tomography (MDCT), intravascular ultrasound (IVUS), and invasive coronary angiography (ICA) findings in a case of spontaneous coronary artery dissection of the left anterior descending artery in a previously healthy 23-year-old man. The role of coronary computed tomographic angiography (CCTA) in diagnosis and management of this potentially life-threatening condition is discussed.
Conclusions: In the clinical setting of acute coronary syndrome, SCAD must be a consideration, particularly in young patients without clear risk factors for coronary artery disease and in women in the peripartum period. CCTA is a very helpful diagnostic tool to diagnose the condition in a non-invasive manner and to follow up after treatment.

Keywords: Coronary Vessel Anomalies - surgery, Coronary Angiography, multidetector computed tomography, Multimodal Imaging, Risk Factors, Ultrasonography, Interventional, Vascular Diseases - surgery, young adult



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