Burkhard, Nina

Herzog, Bernhard

Husmann, Lars

Kaufmann, Philipp

Valenta, Ines

Weber, Klaus

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IMAGE OF THE MONTHCoronary artery ectasia causing ischemiaLars Husmann & Bernhard A. Herzog & Nina Burkhard &Ines Valenta & Klaus Weber & Philipp A. KaufmannReceived: 19 June 2008 /Accepted: 29 June 2008 / Published online: 6 August 2008# Springer-Verlag 2008A 46-year-old male smoker (70 kg, 175 cm) with no othercardiovascular risk factors presented with recurrent episodesof chest discomfort and breathing distress at physical exercise.Cardiac stress testing on a treadmill ergometer was clinicallypathologic at 100 W, and the patient was subsequentlyreferred to non-invasive hybrid cardiac imaging.99mTc-Tetrofosmin single-photon emission computedtomography (SPECT) images were acquired using a 1-dayadenosine-stress/rest protocol and fused with a low-dose,prospectively gated computed tomography coronary angi-ography (effective radiation dose 1.6 mSv) [1, 2]. The latterrevealed ectasia in the left anterior descending, thecircumflex, and the right coronary artery (LAD, CX, RCAin panel B), but no relevant coronary artery stenosis.However, a reversible perfusion defect (ischemia) in theanterior myocardium was demonstrated by adenosine-stressSPECT (bluish colors in panel A; rest scan not shown).Both ectasia and the absence of significant coronaryartery stenosis were confirmed by invasive coronaryangiography, suggesting conservative treatment [3].References1. Gaemperli O, Schepis T, Valenta I, et al. Cardiac image fusion from stand-alone SPECTand CT: clinical experience. J NuclMed. 2007;48:696–703.2. Husmann L, Valenta I, Gaemperli O, et al. Feasibility of low-dosecoronary CT angiography: first experience with prospective ECG-gating. Eur Heart J 2008;29:191–7.3. Kruger D, Stierle U, Herrmann G, et al. Exercise-induced myocardialischemia in isolated coronary artery ectasias and aneurysms (“dilatedcoronopathy”). J Am Coll Cardiol 1999;34:1461–70.Eur J Nucl Med Mol Imaging (2008) 35:2142DOI 10.1007/s00259-008-0895-xL. Husmann :B. A. Herzog :N. Burkhard : I. Valenta :K. Weber : P. A. Kaufmann (*)Cardiovascular Center, University Hospital Zurich,Raemistrasse 100,8091 Zurich, Switzerlande-mail: pak@usz.chP. A. KaufmannZurich Center for Integrative Human Physiology,University of Zurich,Zurich, Switzerland

Coronary artery ectasia causing ischemia

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Coronary artery ectasia causing ischemia

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