Coronary artery vasculitis: assessment with cardiac multi-detector computed tomography

Jeon, Chang Ho; Kim, Yeo Koon; Chun, Eun Ju; Kim, Jeong‐A; Yong, Hwan Seok; Doo, Kyung Won; Choi, Sang Il

doi:10.1007/s10554-015-0652-8

Cited by 15 publications

(11 citation statements)

References 33 publications

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“…Takayasu arteritis, a vasculitis that primarily affects the aorta and large vessels, often involves coronary arteries and causes aneurysmal dilatation or stenosis. Identification of a normal origin of the coronary arteries without fistulous connections enables differentiation between these vasculitides involving coronary arteries and CAFs (65). The differential imaging findings of diseases that cause dilated coronary arteries are summarized in Table E1.…”

Section: Differential Diagnosis Of Cafmentioning

confidence: 99%

Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management

2018

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Coronary artery fistulas (CAFs) are abnormal communications of coronary arteries whereby venous circuits bypass the normal capillaries within the myocardium. CAFs are rare, and most affected patients are asymptomatic. However, these fistulas are the most common coronary artery anomalies that can alter coronary hemodynamic parameters. Although most CAFs are asymptomatic in young patients, symptoms and complications become more frequent with increasing age. CAFs are characterized by variable clinical manifestations that are based on the size, origin, and drainage site of the fistula. In symptomatic cases, surgical ligation or percutaneous transcatheter closure is often recommended. Although CAFs historically have been evaluated with conventional invasive angiography, electrocardiographically gated cardiac computed tomographic (CT) angiography has emerged as the noninvasive alternative modality of choice owing to the high spatial and temporal resolution and short acquisition time. Furthermore, three-dimensional volume-rendered CT angiograms facilitate accurate assessment of the complex anatomy of CAFs, including their origin, drainage site, and complexity and the number and size of fistulous tracts. Knowledge of these characteristics is crucial for therapeutic planning. Radiologists must be aware of the pathophysiology, clinical manifestations, and characteristic CT angiographic findings of CAFs; appropriate CT angiographic protocols for evaluation of various CAFs; and the role of CT angiography in preprocedural planning and follow-up. Online supplemental material is available for this article. RSNA, 2018.

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Section: Differential Diagnosis Of Cafmentioning

confidence: 99%

Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management

2018

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“…2 Coronary artery vasculitis has been most frequently reported with Takayasu arteritis and polyarteritis nodosa, but it has been associated with many other large-, medium-, and small-vessel vasculitides such as giant-cell arteritis, Kawasaki disease, eosinophilic granulomatosis with polyangiitis, and Behçet disease. 3 Coronary vasculitis has also been described as a manifestation of autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis, infectious diseases, including tuberculosis and syphilis, and a variety of other conditions, including lysosomal storage and metabolic diseases. 1 The pathophysiology of coronary involvement is a function of the underlying systemic process.…”

Section: Discussionmentioning

confidence: 99%

“…In systemic vasculitis, perivascular inflammatory infiltrates invade the coronary arterial walls, causing concentric intimal thickening, often further complicated by coronary aneurysm formation and intramural thrombosis. 3 Rheumatologic diseases are also associated with inflammatory intimal thickening, often exacerbated by fibrosis, fibrinoid necrosis, and immune complex deposition. Some infectious diseases can directly invade or seed the coronary arteries, and certain metabolic diseases can cause metabolic substances to deposit in the coronary arterial walls.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 The diagnostic accuracy is limited by nonspecific findings that can be difficult to distinguish from typical atherosclerotic disease. When coronary angiography findings are nonspecific, the use of intracoronary imaging with intravascular ultrasound and OCT has been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Intracoronary nitroglycerin, which often improves coronary stenosis secondary to vasospasm, also can be used to help differentiate vasospasm from vasculitis, which is usually unaffected by nitroglycerin. In addition to invasive techniques, noninvasive imaging with cardiac multidetector computed tomography has been described for coronary vasculitis 3 The utility of noninvasive imaging compared with angiography and intracoronary imaging for the diagnosis of coronary vasculitis has not been studied.…”

Section: Discussionmentioning

confidence: 99%

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Acute Coronary Syndrome in a 52-Year-Old Woman With Scleroderma

et al. 2016

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ForewordInformation about a real patient is presented in stages (boldface type) to expert clinicians (Drs Mauri and Dr MacRae), who respond to the information, sharing their reasoning with the reader (regular type). A discussion by the authors follows. P atient presentation: A 52-year-old woman with a medical history of an acute coronary syndrome (ACS) managed with percutaneous coronary intervention (PCI) and scleroderma presented to outpatient cardiology clinic with chest discomfort. She was in her usual state of health until 1 week before presentation, when she developed fatigue and malaise that persisted throughout the week. On the evening before presentation, she awoke with substernal chest pressure that worsened over the next several hours and prevented her from falling back asleep. She presented to her primary cardiologist the following morning with ongoing chest discomfort.Her medical history was notable for a prior circumflex PCI, diffuse cutaneous systemic sclerosis, mononeuritis multiplex, thrombocytopenia, hypertension, hyperlipidemia, hypothyroidism, and gastroesophageal reflux disease. Her PCI occurred 1 year earlier, when she presented with atypical chest pain in the setting of a scleroderma flare and was found to have lateral ST depressions on her ECG and an elevated troponin T level of 0.12 ng/mL. Coronary angiography was performed and revealed 99% occlusion of the left circumflex artery (LCx; Figure 1). The lesion was successfully treated with a everolimus-eluting stent.Her scleroderma was first diagnosed at 29 years of age, when she presented with Raynaud syndrome, sclerodactyly, telangiectasias, and esophagitis and was found to have a positive anticentromere antibody, leading to a diagnosis of limited cutaneous systemic sclerosis. At 34 years of age, she developed widespread skin thickening and subcutaneous calcinoses, leading to a subsequent diagnosis of diffuse cutaneous systemic sclerosis. At 42 years of age, she developed multiple mononeuropathies with electromyographic evidence of mononeuritis multiplex, for which she was treated with a limited course of cyclophosphamide and prednisone with subsequent clinical improvement.Her thrombocytopenia was chronic and without a clear origin. Prior workup revealed positive anti-cardiolipin IgM and anti-β2-glycoprotein 1 antibodies that were thought to be nonspecific. She had no prior thromboembolic events.Her home medications included aspirin 81 mg daily, clopidogrel 75 mg daily, lisinopril 40 mg daily, levothyroxine 50 μg daily, and pantoprazole 40 mg daily. Her scleroderma and mononeuritis multiplex flares were managed with intermittent mycophenolate mofetil and prednisone, which last occurred ≈6 months before presentation. She was married and worked as a nurse educator. She rarely consumed alcohol and had never used tobacco products or illicit substances. Her mother suffered a myocardial infarction in her 50s and later died of heart failure. Her father died at a young age in a motor vehicle accident.On presentation to her cardiologist's office, s...

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Wellens syndrome in a young woman with coronary artery vasculitis

Ono

Takahashi

Hori

et al. 2021

J of Gen and Family Med

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We report the case of a 30‐year‐old woman who was referred to our hospital with chest pain. An electrocardiogram showed biphasic T‐wave inversions in leads V2–4 compared with that done 2 years ago, suggesting Wellens syndrome, and an emergent coronary angiography revealed significant stenosis of the proximal left anterior descending artery due to coronary artery vasculitis. Although acute coronary syndrome in the young is very rare, coronary artery vasculitis should be considered as a possible etiology, especially in young women with chest pain.

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Coronary artery vasculitis: assessment with cardiac multi-detector computed tomography

Cited by 15 publications

References 33 publications

Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management

Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management

Acute Coronary Syndrome in a 52-Year-Old Woman With Scleroderma

Wellens syndrome in a young woman with coronary artery vasculitis

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