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Wk 5, Case 1 - Review

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Patient History
Chest pain in a 41-year-old male with a family history of early coronary artery disease with myocardial infarction in his mother at 55 years of age.

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 short 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 medium sized vessel that wraps around the apex and gives rise to one large branching diagonal vessel. There is a small amount of partially calcified plaque with minimal (1-24%) stenosis of the proximal LAD. There is a small amount of partially calcified plaque (spotty calcification) with mild (25-49%) stenosis of the mid LAD. There is a small amount of partially calcified plaque with minimal (1-24%) stenosis of the first diagonal branch.

LEFT CIRCUMFLEX (LCX):

The left circumflex is a large 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 CFX or its branches.

RIGHT CORONARY ARTERY (RCA):

The RCA is a medium size dominant vessel that gives rise to the PDA and PLV branches. There is a small amount of partially calcified plaque with minimal (1-24%) stenosis of the proximal RCA.

NON-CORONARY CARDIAC FINDINGS:

Chambers: Chamber sizes are normal. No filling defects seen.

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 in a two-vessel distribution.

2. Non obstructive coronary artery disease with mild (25-49%) stenosis of the mid LAD and minimal (1-24%) stenosis of the proximal LAD, first diagonal branch, and proximal RCA.

3. Unremarkable non coronary findings.

Recommendations:

CAD-RADS 2 - Mild 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.

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

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