Complementary CT Coronary Angiography after Negative Selective Coronary Angiography

• DOI: 10.5334/jbr-btr.845
• Publication Date: 2015-09-15T12:41:59Z
• Authors: V. Hamoir; P. Borgies; X. Hamoir; J. Kirsch; M. Dupont; S. Kautbally
• Keywords: Medical physics. Medical radiology. Nuclear medicine; 03 medical and health sciences; Images in Clinical Radiology; 0302 clinical medicine; R895-920; 3. Good health

A 53-year-old male was admitted for typical acute chest pain. The ECG showed a mirror image of posterior myocardial ischemia. Initial biology normal but cardiac markers (creatine kinase and troponin) rose later. Echocardiography did not reveal any hypokinetic segment. There no left ventricular dysfunction or valvular disease. pericardial effusion aortic dissection image. This patient treated as “non-ST segment elevation infarction” (NSTEMI), also called subendocardial infarction. selective coronary angiography (SCA) performed the next day after careful examination by several experts, lesion detected. Left ventriculography normal. Cardiac MRI then revealed late focal enhancement, located in mid infero-posterior (Fig. A, arrow). appeared to be ischemic, despite SCA. Computed tomography (CTCA) finally done, showing hypodense image, with an ischemic aspect, same area B, arrow) observed on MRI. Furthermore, CTCA detected tight luminal narrowing material (soft atheroma clot) circumflex branch C, arrow), corresponding suspected territory. In this case, both confirmed etiology identified culprit artery missed