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By Raman, Subha

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13 Sagittal multiplanar reformatted image shows the anomalous circumflex coronary artery arising from the right sinus of Valsalva (arrow). 1182 Chap04 5/14/07 6:17 PM Page 47 CORONARY ANOMALIES 47 CLINICAL CASE 10 A 68-year-old male with a known coronary artery anomaly, managed medically, was referred for coronary CTA to define the origins and proximal courses of the coronary arteries. Invasive angiography showed a single coronary artery arising from the right cusp (Fig. 14), and no coronary artery was seen with injection in the left coronary cusp (Fig.

Evaluation of the patient after orthotopic heart transplantation, who has undergone endomyocardial biopsy, should include assessment not only for CAD but also for unusual complications such as coronary-to-RV fistulas. Prior knowledge of a bridging coronary artery segment might warrant CTA acquisition without ECG dose modulation applied, insuring sufficient image quality during systolic phases when compression of the bridging segment occurs. The irregular coronary lumen in the absence of atherosclerotic disease should raise the suspicion of a vasospastic segment, particularly within the appropriate clinical context.

Role of CTA: Notably, this patient had CTA examination completed without supplemental nitroglycerin administration. It is uncertain if this finding would have been feasible in the current era of nitroglycerin-enhanced coronary CTA. 55 Multiplanar reformatted CTA images demonstrate a beaded appearance of the proximal LAD (A, arrow) which may present as substrate for vessel spasm. In comparison, the remaining left and right coronary artery segments appear completely normal (B ). 1182 Chap03 5/14/07 40 6:07 PM Page 40 CARDIOVASCULAR MULTIDETECTOR CT ANGIOGRAPHY CLINICAL PEARLS ● ● ● ● ● ● ● ● CTA can identify calcified, noncalcified, and mixed plaque in the coronary arteries.

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