Presentation
Intermittent chest pain on exertion. Positive exercise stress test.
Patient Data
Calcium score: (Non contrast CT scan)
The calcium score (total volume score) is 0 (zero). It indicates the absence of calcified plaque in the coronary tree.
Coronary Angiography
Origins: Normal
Dominance: Left
Right Coronary Artery (RCA): No stenosis. No plaque.
Posterior descending artery (PDA) - No stenosis. No plaque.
Left Main Coronary Artery (LMCA): No stenosis. No plaque.
Left Anterior Descending (LAD): No stenosis. No plaque.
1st diagonal branch (D1), D2 - No stenosis. No plaque.
Circumflex artery (Cx): No stenosis. No plaque.
1st obtuse marginal branch (OM1), OM2 - No stenosis. No plaque.
Posterior left ventricular branch (PLV) - No stenosis. No plaque.
Ramus intermedius artery: Small. No stenosis. No plaque.
Cardiovascular Findings:
Single right sided SVC. Normal pulmonary venous connections. Pericardium and pericardial space appears unremarkable. No valvular calcification. No other structural cardiac abnormalities identified.
Heart is not enlarged (Cardiothoracic ratio <0.5)
Case Discussion
According to Coronary artery disease- reporting and Data System (CAD-RADS), in stable chest pain, this patient is categorized as CAD-RADS 0, no evidence of coronary artery stenosis.
In CAD-RADS, if there is presence of plaque, the vulnerability of the plaque to indicate high risk plaque should be assessed.
The vulnerable plaque includes
1. Positive remodeling
2. Low attenuation plaque (<30HU)
3. Napkin-ring sign
4. Spotty calcium
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