1Department of Medical Imaging, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
2Department of Emergency and Intensive Care, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
3Division of Cardiology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
* Corresponding author: Tel: +32 27642952; fax: +32 27705574. E-mail address: coche{at}rdgn.ucl.ac.be
A 76-year-old man presented to our emergency department reporting one night of persistent mild constrictive thoracic pain irradiating between both scapulae. His past medical history was notable for arterial hypertension, hypercholesterolaemia, and left iliac artery occlusion. The patient's initial vital signs included a heart rate of 61 bpm, blood pressure of 135/75 mmHg at right arm, and 144/76 mmHg at left arm. The first ECG did not show any acute ischaemic pattern. Blood sample revealed a troponin value of 1.15 ng/mL (normal <0.06 ng/mL). A computed tomography (CT) scan of the chest was requested to rule out an acute aortic dissection.
Retrospective ECG-gated 16-slice CT (MX Brilliance 16 power, Philips Medical Systems, Cleveland, OH) of the entire chest was performed in one breath-hold after injection of contrast medium with 16x1.5 mm collimation. No aortic dissection was seen, but reformatted oblique images (Panel A) reconstructed at the diastolic phase revealed severe stenosis of the left subclavian artery (curved arrow), an irregular right coronary artery (RCA) with an acute occlusion of its distal portion (straight arrow). Frontal view performed at the mid-part of the left ventricle (Panel B) demonstrates hypoperfused area of myocardium at the inferior part of the left ventricle (straight arrows). Curved images reconstruction (Panel C) performed in the plane of the RCA more precisely delineates the site of the RCA occlusion (straight arrow), highlighted in green on the colour-graded image (Panel D). Angiography of coronary arteries (Panel E) confirmed the CT findings with an occlusion of the distal portion of the RCA (straight arrow).