Visualization of Left Main Coronary Dissection by Magnetic Resonance Coronary Angiography
A 50-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.
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.
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.
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