Occluded right coronary artery - STEMI

Case contributed by Dr Henry Knipe

Presentation

Chest pain ?aortic dissection.

Patient Data

Age: 70 years
Gender: Male

ECG-gated thoracic angiogram

ct

Mild ascending aorta ectasia measuring up to 4.1 cm. No evidence of aortic dissection. Scattered atherosclerotic plaque. 

Right coronary artery is not opacified in its mid to distal course and is thickened. Left coronary artery opacifies normally. 

No pericardial effusion.

ECG trace demonstrates ST elevation (classic "tomb-stone" appearance). 

Case Discussion

This patient's STEMI had been diagnosed prior to the CT and had been treated with thrombolysis (no access to cardiac catheterization). The CT angiogram was performed as the patient had continued chest pain and persistent ST elevation and the treating team was concerned about an aortic dissection.

This case demonstrates that coronary artery pathology can be seen and diagnosed without a dedicated coronary artery CT (and expert readers!). 

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