CT
What type of coronary anomaly or coronary variation is shown here?
There is a long and deep myocardial bridge of a strong ramus intermedius artery. Based on CT they can be characterised with regard to the depth and length of the tunnelled artery. Superficial (<2 mm) and short myocardial bridges are considered to be typically asymptomatic, whereas deep (> 2mm) or long (> 25mm) myocardial bridges might be associated with myocardial ischaemia.
What would be the CAD-RADS category for this case - according to CAD-RADS 2.0?
CAD-RADS 1/P2/E
Technique
patient premedication: beta blockers and nitrates
acquisition method: step and shoot (prospective acquisition)
contrast injection protocol: triphasic injection
standard image reconstruction
Findings
normal coronary origins and proximal courses
balanced coronary arterial dominance
Plaque burden:
coronary calcium score: <100
segment involvement score (SIS): two segments
Right coronary artery (RCA): gives rise to a small duplicate posterior descending artery
ostial non-stenotic calcified plaque
otherwise no stenoses in the proximal, middle, and distal segments
posterior descending artery (PDA): no plaques or stenosis
Left main (LM): inconspicuous
Left anterior descending artery (LAD): two diagonal branches
mixed plaque with spotty calcifications and minimal stenosis (D: <25%) near the origin of the first diagonal branch
no plaques or stenoses of the diagonal branches (D1 & D2)
Ramus intermedius: strong
-
long and deep myocardial bridge (length: ~3-4 cm; depth: ~5mm)
Circumflex artery (CX): obtuse marginal branch and left posterolateral branches
no plaques or stenoses in the main epicardial vessel
no plaques or stenosis of the obtuse marginal (OM) and left posterolateral branch
Impression
long and thick myocardial bridge of the strong ramus intermedius artery
small mixed non-obstructing coronary plaque with high-risk features of the LAD and calcified eccentric non-obstructing ostial plaque of the RCA
mild plaque burden
CAD-RADS 1/P2/E
Exam courtesy: Yvonne Kühn (radiographer)