Spontaneous coronary artery dissection on multiple detector computed tomography (MDCT)

Abstract

A 40-year old woman sought treatment of sudden-onset chest pain. Initial electrocardiogram and troponin-I were normal. Coronary multidetector computed tomography (MDCT) angiogram was obtained with a 16-slice scanner (Philips Brilliance; voltage, 140 kVp; current, 500 mA; 0.5-second rotation time; collimation, 16 × 0.75 mm; 100 mL iodixanol was injected at 5 mL/sec). Images were reconstructed at each 10% of RR interval. The coronary calcium score was 0. Curved multiplanar-reformat image of the right coronary artery (RCA) showed multiple eccentric lesions (Fig. 1A). An axial thin-slice maximum-intensity projection (5-mm) image (Fig. 1B) and the “virtual” intravascular ultrasound view from the cross-sectional reconstruction perpendicular to centerline of RCA (Fig. 1C) showed a double lumen (false and true), consistent with coronary dissection. Invasive angiography confirmed extensive spiral dissection in the RCA (Fig. 2) which was treated with placement of 3 coronary stents. She remains asymptomatic 1 year later. Figure 2Invasive coronary angiogram of the RCA showing extensive spiral dissection. View Large Image Figure Viewer Download Hi-res image