This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by von dem Bussche, N. Articles by Mahmud, E. Search for Related Content PubMed PubMed Citation Articles by von dem Bussche, N. Articles by Mahmud, E. Related Collections Cardiovascular imaging agents/Techniques Coronary imaging: angiography/ultrasound/Doppler/CC CT and MRI

(Circulation. 2004;109:432.)
© 2004 American Heart Association, Inc.

Images in Cardiovascular Medicine

Imaging of Intracoronary Thrombus by Multidetector Helical Computed Tomography Angiography

Nicolas von dem Bussche, MD; David L. Isaacs, MD; Eric T. Goodman, MD; Alborz Hassankhani, MD, PhD; Ehtisham Mahmud, MD

From the Divisions of Radiology and Cardiology, University of California, San Diego.

Correspondence to Ehtisham Mahmud, MD, UCSD Medical Center, Division of Cardiology, 200 West Arbor Dr, San Diego, CA 92103-8784. E-mail emahmud{at}ucsd.edu

An 83-year-old woman presented to the emergency department with a 2-hour history of sudden chest pain and dyspnea. An initial ECG demonstrated nonspecific ST changes, and a portable chest x-ray suggested a widened mediastinum. A thoracic multidetector helical computed tomography (CT) angiogram was obtained to assess the possibility of aortic dissection (GE LightSpeed Plus, 2.5-mm collimation with 1.25-mm reconstructions, 700-ms rotation time; 140 mL Optiray 320 nonionic iodinated contrast injected using Smartprep algorithm, pitch of 1.5:1). The CT angiogram demonstrated a low-density filling defect in the proximal left anterior descending coronary artery (LAD), which suggested a thrombus (Figure 1). Coronary angiography then demonstrated a 95% stenosis of the proximal LAD with evidence of a thrombus (Figure 2).

View larger version (154K): [in this window] [in a new window]   Figure 1. Thoracic CT angiogram revealing a large, low-density filling defect in the proximal LAD (arrow). AA indicates abdominal aorta; PA, pulmonary artery; LIPV, left inferior pulmonary vein; and SVC, superior vena cava.

View larger version (117K): [in this window] [in a new window]   Figure 2. Coronary angiogram (right anterior oblique cranial view) confirming a 95% stenosis of the proximal LAD with evidence of a thrombus (arrow).

These findings highlight the potential utility of CT angiography in the diagnosis of an acute coronary syndrome. New multidetector, helical CT scanners with timed, rapid contrast boluses can image the chest with high resolution in a single breath-hold. In addition, multiplanar reconstructions make detailed angiographic evaluation possible and extend the utility of CT in cardiac imaging well beyond calcium scoring in electron-beam CT. Such scanners are already routinely used for the emergent evaluation of pulmonary embolism and aortic dissection. With advancements such as cardiac gating, perhaps CT angiography could be used as a screening tool in the evaluation of chest pain and help in identifying unstable thrombotic coronary lesions.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by von dem Bussche, N. Articles by Mahmud, E. Search for Related Content PubMed PubMed Citation Articles by von dem Bussche, N. Articles by Mahmud, E. Related Collections Cardiovascular imaging agents/Techniques Coronary imaging: angiography/ultrasound/Doppler/CC CT and MRI