Presentation
Chest pain.
Patient Data
CORONARY ANATOMY:
The coronary arteries arise in normal position. There is co-coronary artery dominance.
Left main: There is mild calcified plaque with minimal (<25%) stenosis. Left main trifurcates into LAD, Ramus and LCx.
Left anterior descending: There is moderate eccentric calcified plaque in mid LAD immediately distal to the origin of first diagonal with minimal (<25% stenosis). There is bridging of distal LAD immediately distal to the origin of second diagonal (~ 3 cm long and ~ 0.3 cm deep) with a moderate stenosis (50-69%). Both first and second diagonal branches are small calibre vessels.
Left circumflex: There is scattered calcified plaque in LCx proper and obtuse marginal branches with minimal (less than 25%) stenosis. First obtuse marginal branch has a high origin and is intermediate in calibre. Second obtuse marginal is a large-calibre vessel. LCx gives off the posterior lateral branch and a small left-PDA making codominant system.
Ramus intermedius branch: Intermediate calibre vessel with scattered calcified plaque with minimal (< 25%) stenosis.
Right coronary artery: There is a focal mixed plaque in proximal to mid RCA with minimal (< 25%) stenosis. Gives off a large patent PDA.
CARDIAC MORPHOLOGY:
LV: Concentric left ventricular hypertrophy
RV: Normal.
LA: Four pulmonary veins are seen draining into the left atrium. There is no left atrial appendage thrombus.
RA: Normal.
Valvular calcification: There is mild mitral annular calcification. There is mild aortic valvular calcification.
Pericardium: Pericardial contour is preserved without effusion, thickening or calcifications.
Case Discussion
The coronary arteries usually course epicardially, but in up to 30% of the population, the coronaries may take an intramuscular course. This anomalous intramuscular course is known as bridging and is asymptomatic in most people. The LAD is the most commonly involved vessel.
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