Case Presentation. This is the first report of spontaneous coronary artery dissection (SCAD) initially diagnosed by 64-slice

Figure 1

(A) Curved multiplanar reconstruction of the right coronary artery (RCA) computed tomographic angiogram demonstrating spontaneous dissection characterized by two parallel lumens. (B) Corresponding selective coronary arteriography displaying the area of dissection (arrow). (C) RCA after stent placement.

multidetector computed tomographic angiography (CTA) (Figures 1–3). The patient was a 53-year-old

Figure 2

Straightened multiplanar reconstruction of the right coronary artery with two tomographic intravascular analysis (TIVA) cross-sections of the area of dissection.

male with prior myocardial infarction not treated with percutaneous coronary intervention, and increasing dyspnea on exertion. Following the diagnosis of SCAD by CTA, he underwent selective coronary angiography (Figure 1) and intravascular ultrasound (Figure 3), which confirmed the dissection. Successful stenting of the right coronary artery lesion was performed (Figure 1). The almost identical Hounsfield Units in the two lumens on CTA is of critical importance (Figure 3), and differentiates between dissection and contrast adjacent to calcified plaque, which is very unlikely to be of the same density as

Figure 3

Top: Cross-sectional image from Figure 2 with classical feature of dissection represented by similar Hounsfield units (HU) in the 2 lumens, separated by lower density soft tissue. Bottom: Corresponding intravascular ultrasound image, demonstrating true lumen (TL) and false lumen (FL).

contrast.

       SCAD is extremely uncommon (incidence of 0.3–1.1% among patients undergoing cardiac catheterization), with > 70% of the reported cases are diagnosed postmortem. Typically, SCAD involves the left coronary system, is usually reported in women without traditional risk factors who are taking oral contraceptives or during the postpartum period. In men, SCAD tends to involve the right coronary artery and is associated with atherosclerosis. Successful treatment by percutaneous intervention or bypass surgery has been previously reported.