Attenuation artifact mimicking coronary artery disease

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Presenting with chest pain. Adenosine nuclear stress test performed without prone stress images. BMI 47.

Patient Data

Age: 65 years
Gender: Male

Gating is good, quality of study is adequate.

Big body habitus. No prone stress images obtained.

Normal ejection fraction with normal LV wall motion and thickening.

When you find these normal findings with abnormal radiotracer uptake, an overcall of infarction and ischemia may be made based on the sliced images and polar maps.

But a differential of attenuation artifact should also be provided to the clinician to decide further work up.

Case Discussion

The case was discussed with the cardiologist.

An echocardiogram was done and it confirmed no wall motion abnormalities corresponding to the areas of large infarct or ischemia in the lateral and inferior walls.

Given the patient's large body habitus, an attenuation artifact is more likely.

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