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Wk 4, Case 4 - Review

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Patient History
48-year-old male with a history of chest pain and mixed hyperlipidemia.
Report
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: MDCT CT scanner with a 0.25 s rotation time
IVCM: 85 mL Administered @ 6 mL/s
Medication: Sublingual nitroglycerin 0.8 mg, 200mg oral metoprolol
Heart rate: 60 bpm
Rhythm: sinus rhythm
Artifacts: none.
Findings:
Coronary CTA:
The quality of the exam is good.
The left and right coronaries arise from their respective normal anatomic ostia. The coronary circulation is right dominant.
LEFT MAIN:
The left main coronary artery is a long vessel that gives rise to the LAD, and LCx arteries. There is no plaque or stenosis in the left main.
LEFT ANTERIOR DESCENDING (LAD):
The LAD is a large vessel that wraps around the apex and gives rise to two diagonal branches. There is a small amount of non-calcified plaque with minimal (1-24%) stenosis of the proximal LAD. There is no plaque or stenosis in the remainder of the LAD or its branches.
LEFT CIRCUMFLEX (LCX):
The left circumflex is a medium sized vessel that gives rise to two-obtuse marginal branches before terminating as a diminutive vessel in the AV groove. There is no plaque or stenosis in the LCX or the OM branches.
RIGHT CORONARY ARTERY (RCA):
The RCA is a medium dominant vessel that gives rise to the PDA and PLV branches. There is no plaque or stenosis in the RCA or its branches.
NON-CORONARY CARDIAC FINDINGS:
Chambers: Chamber sizes are normal. No filling defects seen. Small patent foramen ovale. Myocardium: Normal thickness. No outpouching or masses.
Valves: Normal mitral valve thickening. Trileaflet aortic valve with no thickening. Pericardium: No pericardial effusion, calcification, or thickening.
Aorta: There is no aortic rupture, aneurysm, dissection, intramural hematoma. Pulmonary arteries: No enlargement. No central pulmonary embolism.
Pulmonary veins: Normal venous drainage of all pulmonary veins into the left atrium. No pulmonary vein stenosis.
Impressions
1. Overall, there is a small amount of partially calcified plaque involving the proximal LAD.
2. Non obstructive coronary artery disease with minimal (1-24%) stenosis of the proximal LAD.
Recommendations:
CAD-RADS 1 - Minimal non-obstructive CAD; Consider non-atherosclerotic causes of chest pain. Consider preventive therapy and risk factor modification, particularly for patients with non obstructive plaque in multiple segments.
Plaque: P1 mild 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

Congenital

Cardiac CT (SCCT Cat B1 Video Case)

Cardiac CT

Cardiac

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