Author: Lanett Varnell, MD, and Gordon D. Graham, MD, Imaging Center,
Chattanooga Heart Institute, Chattanooga, TN, USA

History

A 66 year old woman suffering shortness of breath was examined. A performed echocardiography showed abnormal findings. An ECG-synchronized multi-slice CT of the chest was performed to rule out pulmonary embolism or coronary artery disease. Using a collimation setting of 0.6 mm resulted in a spatial resolution 0.33 mm in order to get a detailed analysis of coronary vessels.

Diagnosis and Comments

No evidence of infiltrate or mass could be detected in the lung window. The mediastinal windows did not show lymphadenopathy by size criteria. Also, the cardiothoracic ratio remained within normal limits. A pulmonary diagram demonstrates a pulmonary artery of 1.8 cm in diameter. No pulmonary arterial filling-defect through third order branching could be detected. The thoracic angiogram shows an artifact-free aortic root measuring 3.14 cm without evidence of aneurysm or dissection inside the FOV. Wall thickness and motion were normal, the ejection fraction 65 percent. The coronary arteries were displayed free of motion artifacts. The left main artery (LM) with a length of about 10 mm showed almost circumferential calcifications. The left anterior descending coronary artery (LAD) showed a non-calcified plaque in the proximal one third with possible, clinically significant obstruction. The left circumflex coronary artery (LCX) also suggested diffuse non-calcified plaque with calcifications distally. A potentially significant obstruction was noted in the mid segment of the vessel. Also the right coronary artery (RCA) showed diffuse calcifications with soft plaque, resulting in a diffuse mildly obstructive disease. A structurally normal heart with intact left ventricular function can be concluded. Diffuse atherosclerotic disease was noted including significant calcified and non-calcified plaquing. A triple vessel disease with clinically significant obstruction is suggested. Patient subsequently underwent cardiac catherization followed by coronary artery bypass graft (CABG).

Fig. 1: Normal origin and course of right coronary artery seen.
Fig. 2: Diffuse plaque noted in the left coronary artery.

Fig. 3: Diffuse plaquing, both soft and calcific.
Fig. 4: Normal origin of Left Main.

Fig. 5: Soft plaque probably with clinically significant obstruction.
Fig. 6: Calcified plaque noted three vessel disease noted.