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Acute chest pain in a healthy woman

    Author: María Pilar Calvillo Batllés, Valencia, Spain
    Body Region: Cardiovascular

    1. Patient Presentation
    2. CT Images
    3. CT Findings
    3.1 Additional Information
    4. Diagnosis
    5. References
    Educational cardiac CT case for radiologists and radiographers illustrating spontaneous coronary artery dissection, CAD-RADS classification, CT findings, protocols, and follow-up imaging in acute chest pain.

    1. Patient Presentation

    • A 43-year-old woman developed oppressive central chest pain accompanied by vegetative symptoms.
    • The electrocardiogram (ECG) showed ST-segment elevation in the inferolateral leads consistent with myocardial infarction. The ST-elevation myocardial infarction (STEMI) protocol was activated. High-sensitivity troponin T (hs-TnT) levels were elevated on hospital admission (2,223 ng/L), supporting the diagnosis.
    • Invasive coronary angiography (ICA) revealed a proximally suboccluded circumflex artery with a long, tapering lesion and poor distal flow. As the patient remained symptomatic with persistent ST elevation, cutting-balloon angioplasty was performed. Intravascular ultrasound (IVUS) confirmed satisfactory lumen expansion, with subsequent clinical and ECG improvement. Dual antiplatelet therapy was prescribed.
    • Nine days later, she presented again with oppressive chest pain. ECG showed ST elevation in the inferior and apical leads, with ST depression in V1–V2. The STEMI protocol was again activated. Hs-TnT was 333 ng/L.
    • An ICA was performed, and direct predilatation with a cutting balloon restored TIMI (thrombolysis in myocardial infarction) 3 flow and resolved angina. Given the presence of distal residual stenosis but good flow and the absence of symptoms, the procedure was concluded.
    • A follow-up coronary CT angiography was performed six days later to assess the evolution of the lesion after the percutaneous treatment.
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