title: Zero coronary calcium in the presence of three-vessel and left main coronary artery disease in a Hodgkin lymphoma survivor.
abstract: We describe a 45-year-old male survivor of Hodgkin lymphoma, treated with mediastinal radiation therapy, referred for single-photon emission computed tomography (SPECT) myocardial perfusion imaging in combination with coronary artery calcium (CAC) scoring. SPECT demonstrated a reversible moderate-sized lateral perfusion defect, and the CAC score was zero. A calcium score of zero markedly reduces the probability of having coronary artery disease (CAD) and is associated with a very low risk of future cardiovascular events. However, a CAC score of zero does not completely rule out obstructive CAD. In this case, invasive coronary angiography revealed three-vessel CAD with left main involvement. Whether mediastinal radiation therapy in general is associated with CAD without accompanying CAC is yet unclear.
authors.affiliation: Department of Cardiology, Isala Hospital, Dokter Van Heesweg 2, 8025 AB, Zwolle, The Netherlands, v.r.c.derks@isala.nl.
authors.forename: E M
authors.initials: EM
authors.lastname: Engbers
authors.forename: M
authors.initials: M
authors.lastname: Mouden
authors.forename: P L
authors.initials: PL
authors.lastname: Jager
authors.forename: J R
authors.initials: JR
authors.lastname: Timmer