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Wk 6, Case 4 - Review

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Report

Patient History
28-year-old male with a history of intermittent chest pain with exertion. Request for CCTA for further risk stratification.

Report
PROCEDURE:

1. Cardiac CT Angiography (Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed).) (CPT code: 75574)

TECHNIQUE:

Gating: Prospective; data acquisition between 60-80%

Medications: 50 mg Lopressor, 800 mcg sublingual nitroglycerin

Contrast: 70 mL Visipaque 320 injected at 5 mL/sec.

QC (signal/noise): Fair

Artifacts: Cardiac motion artifact.

Complications: None

Heart rate: 68 bpm.

Findings:
CORONARY ANGIOGRAPHY:

The left and right coronaries arise from a shared coronary ostium in the sinotubular junction above the right coronary cusp. The coronary circulation is right dominant.

Left Main (LM):

The left main is a large caliber vessel that bifurcates into a left anterior descending and left circumflex arteries. The vessel is a branch vessel of the RCA with a non-acute take-off angle (96°) and level above the aortic valve commissure as it follows a retro-aortic course. The proximal vessel has a normal diameter and no evidence of vessel narrowing or an intramural course

Left anterior descending artery (LAD):

The LAD is a medium caliber vessel that supplies two diagonal vessels before terminating as a proximal LAD. The distal LAD originates from the RCA as separate branch with a pre-pulmonic course before terminating as a diminutive vessel near the apex. There is no plaque or stenosis in the LAD or the diagonal branches.

Left circumflex artery (LCX):

The circumflex is a medium caliber, non-dominant vessel that gives rise to two obtuse marginal branches before terminating as a diminutive vessel within the AV groove. There is no evidence of plaque or stenosis within the LCX or OM branches.

Right coronary artery (RCA):

The right coronary artery is a medium caliber, dominant vessel, arising from the right cusp, that gives rise to acute marginal branches before terminating as the posterior descending artery and postero-lateral branches. There is no evidence of plaque or stenosis in the proximal RCA, distal RCA, PDA and PLB. The mid RCA is non evaluable due to motion artifact.

NON-CORONARY CARDIAC FINDINGS:

Chambers: Left atrial size is normal in size with no left atrial appendage filling defect. The ventricular cavity size is within normal limits. There are no abnormal filling defects.

Myocardium: Normal thickness. No outpouching or masses.

Valves: Trileaflet aortic valve with normal leaflet thickening. Normal mitral valve leaflet thickening.

Pericardium: Normal thickness with no significant effusion or calcium present.

Aorta: There is no aortic rupture, aneurysm, dissection, intramural hematoma.

Pulmonary arteries: Normal in size without proximal filling defect. Not fully opacified.

Pulmonary veins: Normal pulmonary venous drainage. There were four noted pulmonary veins, two on the right and two on the left.

Impressions
1. The left and right coronaries arise from a shared coronary ostium in the sinotubular junction above the right coronary cusp. The coronary circulation is right dominant.

2. The left main is a large caliber vessel that bifurcates into a left anterior descending and left circumflex arteries. The vessel is a branch vessel of the RCA with a retro-aortic course and no evidence of high-risk findings.

3. The distal LAD originates from the RCA as separate branch with a pre-pulmonic course with no high-risk findings.

4. The mid RCA is non evaluable for stenosis due to motion artifact.

Case Discussion

Faculty

Giovanni E. Lorenz, DO

Cardiothoracic Radiologist

San Antonio Military Health System (SAMHS)

Emilio Fentanes, MD

Director of Cardiac Imaging, Department of Cardiology

Brooke Army Medical Center

Tags

Vascular

Coronary arteries

Congenital

Cardiac CT (SCCT Cat B1 Video Case)

Cardiac CT

Cardiac

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