Coronary computed tomography angiography of spontaneous coronary artery dissection: a case report and review of the literature.
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.


METHODS
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.
Department of Diagnostic Radiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
Stephanie C
SC
Torres-Ayala
Cardiothoracic Imaging Section, Department of Diagnostic Radiology, University of Puerto Rico, San Juan, Puerto Rico.
Jose
J
Maldonado
Department of Radiology, Radiology Associates, Dothan, AL, USA.
J Scott
JS
Bolton
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
Sanjeev
S
Bhalla
D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D064847:Multimodal Imaging; D012307:Risk Factors; D018084:Ultrasonography, Interventional; D014652:Vascular Diseases / Q000151:congenital* / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D055815:Young Adult