Case for 2/22/2007

Click image to enlarge

CTA: UPPER IMAGE:  AXIAL MIP LAD; LOWER IMAGE: CURVED MPR LAD:

Diagnosis:  LARGE FATTY DENSITY PLAQUE AT THE OSTIUM OF THE LAD

54 y/o Female  with atypical chest pain and abnormal nuclear perfusion.

Discussion:

The upper picture demonstrates an axial swiveled MIP through the LAD and appears normal. The curved MPR demonstrates a large fatty plaque measuring 10mm in length  in the wall of the proximal LAD without significant luminal stenosis.

This case depicts what a waste of time it is to swivel and MIP images as an initial look at the coronaries. I emphasize this point constantly in our courses. With current excellent available workstations, the most efficient way to look at a case is by carefully reviewing the axial source images, followed by curved reformatted display with vessel analysis.

It would be a disservice to the patient to "miss" this plaque which is causing significant positive remodeling in the wall and at possible risk for a future complication, such as rupture and with potential fatal consequences. I would recommend this patient have aggressive medical therapy and a follow-up "low dose" scan in 1-2 years. Scientific studies currently do not back these claims, however, CAD is an inflammatory systemic disease of the wall that should be treated when recognized in order to minimize future risks of an acute coronary syndrome. Also, I'm convinced that if this was your LAD, you'd likely follow my advice and "hedge your bets".

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