title: Spontaneous coronary artery dissection: challenges of coronary computed tomography angiography.
abstract: BACKGROUND
  There is limited understanding of the role of cardiac computed tomography angiography (CCTA) for assessment of patients with spontaneous coronary artery dissection (SCAD).
  
  
  METHODS
  In this report we describe the diagnostic utility of CCTA in three young women presenting with signs and symptoms of myocardial ischemia who were eventually diagnosed with SCAD.
  
  
  RESULTS
  None of the women had traditional atherosclerotic risk factors. SCAD was not initially identified on CCTA in any of the three women, but was visualized during retrospective analysis in two patients after invasive coronary angiography. In two patients follow-up CCTA imaging was used successfully for subsequent management.
  
  
  CONCLUSIONS
  In patients presenting with signs or symptoms of acute coronary syndrome, SCAD may be missed or not detectable on CCTA. A negative CCTA should not exclude a diagnosis of SCAD, and invasive coronary angiography should be considered for further evaluation.
authors.affiliation: 1 Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, USA.
authors.forename: Mackram F
authors.initials: MF
authors.lastname: Eleid
authors.affiliation: 1 Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, USA.
authors.forename: Marysia S
authors.initials: MS
authors.lastname: Tweet
authors.affiliation: 2 Department of Radiology, Mayo Clinic College of Medicine, USA.
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Young
authors.affiliation: 2 Department of Radiology, Mayo Clinic College of Medicine, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Williamson
authors.affiliation: 1 Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, USA.
authors.forename: Sharonne N
authors.initials: SN
authors.lastname: Hayes
authors.affiliation: 1 Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, USA.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gulati
mesh_terms: D000328:Adult; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003330:Coronary Vessel Anomalies / Q000175:diagnosis*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D015203:Reproducibility of Results; D014652:Vascular Diseases / Q000151:congenital* / Q000175:diagnosis
keywords: Spontaneous coronary artery dissection; coronary computed tomography angiography