Upcoming Events
Log In
Pricing
Free Trial

Wk 1, Case 2 - Review

HIDE
PrevNext

Report

Patient History
70-year-old male with a history of recurrent probable cardiac chest pain. 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: 100mg Lopressor, 800 mg nitroglycerin

Contrast: 70mL Visipaque 320 injected at 6 mL/s.

QC (signal/noise): Good

Artifacts: None that are significant.

Complications: None

Heart rate: 52 bpm sinus rhythm.

Findings:
CORONARY ANGIOGRAPHY:

The left and right coronaries arise from their respective normal anatomic ostia.

The coronary circulation is right dominant.

Left Main (LM):

The left main is a large caliber vessel that trifurcates to form a left anterior descending, a ramus intermediate, and a left circumflex artery. There is a small amount of partially calcified plaque with minimal (1-24%) stenosis in the mid-left main.

Left anterior descending artery (LAD):

The LAD is a large caliber vessel that supplies two diagonal vessels before wrapping the apex. There is a large amount of partially calcified and non-calcified plaque with mild (25-49%) stenosis of the proximal LAD, positive remodeling and spotty calcification with a moderate (50-69%) stenosis in the mid-LAD, and minimal (1-24%) stenosis of the first diagonal branch.

Ramus intermedius (RI):

The ramus is a small vessel that supplies part of the anterior wall. There is a small amount of partially calcified plaque with a patent vessel.

Left circumflex artery (LCX):

The circumflex is a medium caliber, a non-dominant vessel that gives rise to one obtuse marginal branch before terminating within the AV groove. There is a small amount of non-calcified plaque with minimal (1-24%) stenosis in the first obtuse marginal branch.

Right coronary artery (RCA):

The right coronary artery is a large 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 a small amount of non-calcified plaque with positive remodeling and mild (25-49%) stenosis of the proximal and mid-RCA and partially calcified plaque with mild (25-49%) stenosis of the posterior descending artery and PLB.

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. The right ventricle is mildly dilated.

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, or intramural hematoma.

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

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

Impressions

1. Overall, there is a large amount of partially calcified and non-calcified plaque with vulnerable plaque characteristics in a multivessel distribution.

2. Obstructive coronary artery disease with a moderate (50-69%) stenosis of the mid LAD, mild (25-49%) stenosis of the proximal LAD, proximal RCA, mid-RCA, PDA, and minimal (1-24%) stenosis of the left main, first diagonal, first obtuse marginal and posterolateral branch.

3. The right ventricle is mildly dilated.

RECOMMENDATIONS:

CAD-RADS: 3 (Moderate stenosis up to 50-69%). Consider anti-anginal therapy if FFR+, consider ICA if frequent symptoms despite aggressive medical therapy. Aggressive risk factor modification and preventive medical care.

CAD-RADS Modifier: High-risk plaque features

Plaque: P3- Severe amount of plaque

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

Cardiac CT (SCCT Cat B1 Video Case)

Cardiac CT

Cardiac

Acquired/Developmental

© 2025 Medality. All Rights Reserved.

Contact UsTerms of UsePrivacy Policy