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(Circulation. 2003;108:1034.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Visualization of Left Main Coronary Dissection by Magnetic Resonance Coronary Angiography

Mihaela Tebeica, MD; Srirama V. Swaminathan, PhD; Neil J. Weissman, MD; Prithvi Rai, MD; Anthon Fuisz, MD

From The Cardiovascular Specialists, Falmouth, Mass (M.T.); Clinical Science, Philips Medical Systems, Bothell, Wash (S.V.S.); and Department of Cardiology, Washington Hospital Center, Washington, DC (N.J.W., P.R., A.F.).

Correspondence to Anthon Fuisz, MD, Department of Cardiology, Rm 4B15-19, Washington Hospital Center, 110 Irving St NW, Washington, DC 20010-2975. E-mail fuiszt{at}aol.com

A50-year-old woman was referred for coronary angiography for evaluation of atypical chest pain. The left system was visualized initially and was normal; however, contrast staining in the mid left main artery was seen after the last injection (Figure 1). A localized dissection of the left main artery was suspected, and an intravascular ultrasound study (Figure 2) confirmed the diagnosis. Because the patient remained clinically asymptomatic and hemodynamically stable, she was referred for magnetic resonance coronary angiography. Black blood imaging of the proximal left system appeared normal. Bright blood imaging (Figure 3), however, revealed a localized dissection in the mid segment of the left main artery.

View larger version (90K): [in this window] [in a new window]   Figure 1. Catheterization images showing contrast staining of the mid left main coronary artery (arrows).

View larger version (130K): [in this window] [in a new window]   Figure 2. Intravascular ultrasound images showing the dissection (arrow) and corroborating the catheterization findings.

View larger version (158K): [in this window] [in a new window]   Figure 3. A reformatted coronary angiogram maximum-intensity projection image showing the dissection (arrow).

Coronary dissection is a rare complication of coronary angiography (incidence: 0.013% to 0.35% in large series). Localized and asymptomatic dissections usually have a benign course, and no treatment is necessary.

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 Tebeica, M. Articles by Fuisz, A. Search for Related Content PubMed PubMed Citation Articles by Tebeica, M. Articles by Fuisz, A. Related Collections Coronary imaging: angiography/ultrasound/Doppler/CC CT and MRI