Why Defining The Anatomy Is Important: CT Coronary Angiogram Following An Abnormal Spect Identifies An Unexpected Finding

Abstract

Introduction: A 73-year-old male patient presented with atypical chest pain radiating to the back of one-week duration. Initial work-up included negative cardiac enzymes, electrocardiogram without signs of ischemia, and a non-contrast-enhanced CT of abdomen and pelvis for concern for renal colic which showed moderate atherosclerotic plaque in the abdominal aorta. The patient underwent an exercise SPECT which showed ST depression in the inferolateral leads with exercise and a small, fixed defect in the apex and inferior region, overall suggestive of intermediate risk for cardiovascular mortality.