title: A Novel Cause of Acute Coronary Syndrome Due to Dynamic Extrinsic Coronary Artery Compression by a Rib Exostosis: Multimodality Imaging Diagnosis.
abstract: We report a case of acute coronary syndrome secondary to intermittent extrinsic compression of the left anterior descending coronary artery by inward-pointing rib exostosis in an 18-year-old woman during forceful repeated expiration in labour. The diagnosis was achieved using multimodality noninvasive cardiac imaging. In particular, we demonstrated the novel role of expiratory-phase cardiac computed tomography in confirming the anatomical relationship of the bony exostosis to the left anterior descending coronary artery. The case reminds us the heart and mediastinum move dynamically, relative to the bony thorax, throughout the respiratory cycle, and that changes in cardiac physiology in pregnancy may become pathological.
authors.affiliation: NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom. Electronic address: jonathan.rodrigues@uhbristol.nhs.uk.
authors.forename: Jonathan C L
authors.initials: JC
authors.lastname: Rodrigues
authors.affiliation: NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: Helen C
authors.initials: HC
authors.lastname: Mathias
authors.affiliation: NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Lyen
authors.affiliation: NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: Elisa
authors.initials: E
authors.lastname: Mcalindon
authors.affiliation: NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: Chiara
authors.initials: C
authors.lastname: Bucciarelli-Ducci
authors.affiliation: Department of Thoracic Surgery, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: Timothy J P
authors.initials: TJ
authors.lastname: Batchelor
authors.affiliation: NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: Mark C K
authors.initials: MC
authors.lastname: Hamilton
authors.affiliation: NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: Nathan E
authors.initials: NE
authors.lastname: Manghat
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D000293:Adolescent; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D036861:Delivery, Obstetric / Q000009:adverse effects; D005096:Exostoses / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D005097:Exostoses, Multiple Hereditary / Q000150:complications*; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D064847:Multimodal Imaging / Q000379:methods; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D011312:Pressure / Q000009:adverse effects; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D012272:Ribs / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome