Imaging of Intracoronary Thrombus by Multidetector Helical Computed Tomography Angiography
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).
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.
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.