CT coronary angiogram (normal)

Case contributed by Dr Hoe Han Guan

Presentation

Intermittent chest pain on exertion. Positive exercise stress test.

Patient Data

Age: 50 years
Gender: Male

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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