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Wk 1, Case 1 - Review

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Patient History
38 years old male with a history of mitral valve prolapse with intermittent chest pain with increased physical exertion. Treadmill stress test equivocal with limiting chest pain, but normal ECG with stress. Coronary CT angiogram was ordered for further risk stratification.
Findings
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: Coronary CT Angiography
Prospective ECG gating Cardiac; data acquisition between 65-80 % of the R-R interval Cardiac CT: dual-source CT scanner with a 0.25 s rotation time
IVCM: 90 mL Administered @ 6 mL/s
Medication: Sublingual nitroglycerin 0.8 mg, 200mg oral metoprolol
Heart rate: 50 bpm
Rhythm: sinus rhythm
Artifacts: none.
The technical quality of the scan: good.
CORONARY FINDINGS:
The left and right coronary ostia are in a normal anatomic position.
The coronary anatomy is right dominant.
LEFT MAIN:
The left main coronary artery is a short, large caliber vessel that trifurcates into the LAD, RI, and LCX. There is no plaque or stenosis in the left main.
LEFT ANTERIOR DESCENDING (LAD):
The LAD is a large caliber vessel that gives rise to three small diagonal branches and wraps around the apex. There is no plaque or stenosis in the LAD and its branches.
RAMUS INTERMEDIUS (RI):
The RI is a medium-caliber vessel that courses along the lateral wall. There is no plaque or stenosis in the RI.
LEFT CIRCUMFLEX (LCX):
The LCX is a non-dominant vessel that gives rise to one OM branch before terminating as a small vessel in the AV groove. There is no plaque or stenosis of the LCX or the OM branch.
RIGHT CORONARY ARTERY (RCA):
The RCA is a dominant vessel and gives rise to a PDA and the PLB branches. There is no plaque or stenosis in the RCA or its branches.
NON-CORONARY CARDIAC FINDINGS:
Chambers: Normal left ventricular cavity size. Normal left atrial size. Normal right ventricular cavity size with normal right atrial size.
Myocardium: Normal wall thickness.
Valves: Trileaflet aortic valve with normal leaflet thickness. Normal mitral valve structure and mild leaflet thickening.
Pericardium: No pericardial effusion, calcification, or thickening.
Aorta: No aortic rupture, aneurysm, dissection, or intramural hematoma. Pulmonary arteries: No enlargement. No central pulmonary embolism.
Pulmonary veins: There is normal pulmonary venous return to the left atrium.
Impressions
1. Overall, there is no plaque or stenosis in the coronary arteries.
2. Mildly thickened mitral valve leaflets.
CADRADS 0: No plaque or stenosis. Absence of CAD. Reassurance. Consider non - atherosclerotic causes of symptoms.

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

Pericardium

Myocardium

Coronary arteries

Congenital

Cardiac valves

Cardiac Chambers

Cardiac CT (SCCT Cat B1 Video Case)

Cardiac CT

Cardiac

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