False Negative Echocardiography in an Adolescent with Anomalous Left Main Coronary Artery Origin Presenting with Cardiac Arrest

Abstract

A 13-year-old boy with attention deficit hyperactivity disorder treated with atomoxetin experienced cardiac collapse after physical exercise with exposure to cold water. After resuscitation using a mechanical chest compression device and treatment with extracorporeal heart lung assist, coronary angiography showed abnormal origin of the left main coronary artery and severe stenosis, which was stented. In early childhood, transthoracic echocardiography was interpreted as showing normal origins and courses of coronary arteries. The patient died, and autopsy confirmed the abnormal origin of the left main coronary artery coursing between the pulmonary artery and aorta. This case demonstrates that two-dimensional transthoracic echocardiography can lead to false negative diagnosis when assessing the origin of the left coronary artery. Thus, echocardiography may be inferior to computed tomography or magnetic resonance imaging in assessing coronary artery abnormalities.