Presentation
Chest pain.
Patient Data
The coronary arteries arise in a normal position. There is right coronary artery dominance.
Left main: The left main coronary artery bifurcates into the LAD and LCX. Atherosclerotic plaque with minimal stenosis (1-24%).
Left anterior descending: There is diffuse luminal irregularity due to predominantly noncalcified plaque, with associated spotty calcifications and positive remodeling within the mid LAD resulting in severe stenosis. Additional moderate stenosis of the LAD after the second diagonal branch.
Left circumflex: no plaque and/or stenosis
Right coronary artery: Gives off a patent posterior descending artery and a patent posterior left ventricular branch. Calcified and non-calcified plaque in the mid-RCA with mild stenosis (25-49%).
Case Discussion
"Spotty calcifications" are small areas of vessel wall calcification and are one of the four characteristic features of vulnerable plaque at risk for rupture and subsequent vessel thrombosis.
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