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Clinical Images
Spontaneous Right Coronary Artery Dissection: Evaluation by
64-Slice Multidetector Computed Tomographic Angiography
June 2007
Case Presentation. This is the first report of spontaneous coronary artery dissection (SCAD) initially diagnosed by 64-slice multidetector computed tomographic angiography (CTA) (Figures 1–3). The patient was a 53-year-old male with prior myocardial infarction not treated with percutaneous coronary intervention, and increasing dyspnea on exertion. Following the diagnosis of SCAD by CTA, he underwent selective coronary angiography (Figure 1) and intravascular ultrasound (Figure 3), which confirmed the dissection. Successful stenting of the right coronary artery lesion was performed (Figure 1). The almost identical Hounsfield Units in the two lumens on CTA is of critical importance (Figure 3), and differentiates between dissection and contrast adjacent to calcified plaque, which is very unlikely to be of the same density as contrast.
SCAD is extremely uncommon (incidence of 0.3–1.1% among patients undergoing cardiac catheterization), with > 70% of the reported cases are diagnosed postmortem. Typically, SCAD involves the left coronary system, is usually reported in women without traditional risk factors who are taking oral contraceptives or during the postpartum period. In men, SCAD tends to involve the right coronary artery and is associated with atherosclerosis. Successful treatment by percutaneous intervention or bypass surgery has been previously reported.
References
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