Upcoming Events
Log In
Pricing
Free Trial

Wk 3, Case 5 - Review

HIDE
PrevNext

Report

Patient History

53-year-old male with a history of mixed hyperlipidemia and hypertension with recurrent chest pain and an abnormal stress myocardial perfusion scan. Request for CCTA to rule out left main disease.

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 70-75%

Medications: 200mg Lopressor, 800 mg nitroglycerin

Contrast: 85mL Visipaque 320 injected at 6 mL/s.

QC (signal/noise): Good

Artifacts: None that are significant.

Complications: None

Heart rate: 62 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 bifurcates to form a left anterior descending artery, and a left circumflex artery. There is a small amount of non-calcified plaque with minimal (1-24%) stenosis of the proximal left main.

Left anterior descending artery (LAD):

The LAD is a large caliber vessel that supplies three diagonal vessels before wrapping the apex. There is a medium amount of partially calcified plaque with minimal (1-24%) stenosis of the proximal LAD, and mild (25-49%) stenosis in the mid LAD. There is small amount of partially calcified plaque with minimal (1-24%) stenosis in first diagonal branch and non-calcified plaque with minimal (1-24%) stenosis of the second diagonal branch.

Left circumflex artery (LCX):

The circumflex is a medium caliber, non-dominant vessel that gives rise to two obtuse marginal branches before terminating within the AV groove. There is no plaque or stenosis in the left circumflex.

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 posterolateral branches. There is a medium amount of partially calcified plaque with positive remodeling with minimal (1-24%) stenosis in the proximal RCA. There is a small amount of partially calcified plaque with minimal (1-24%) stenosis in the distal RCA extending into the PDA.

NON-CORONARY CARDIAC FINDINGS:

Chambers: Left atrial size is normal in size with no left atrial appendage filling defect. The left 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.

The aorta is dilated at the sinuses of Valsalva measuring 4.0 x 4.1 x 4.0 cm.

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. Overall, there is a large amount of partially calcified plaque in a two-vessel distribution including the left main.

2. Non-obstructive coronary artery disease with mild (25-49%) stenosis of the

mid LAD, and minimal (1-24%) stenosis of the left main, proximal LAD, diagonal branches, proximal and distal RCA.

3. The aorta is dilated at the sinuses of Valsalva. Recommend serial monitoring.

RECOMMENDATIONS:

CAD-RADS: 2 (CAD-RADS 2 - Mild non-obstructive CAD) Consider non-atherosclerotic causes of chest pain. Recommend preventive therapy and risk factor modification.

Plaque: P3 severe amount of plaque.

Final diagnosis: I25.10 CAD, native

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