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| Patient: 65 year old male |
| History: Known history of coronary artery disease (s/p distal LAD stent placement 7 months prior to presentation). Now presents with chest pain and dyspnea on exertion. Adenosine stress test was positive. |
Image Size:[small][as-submitted]
[small][as-submitted]
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| Findings: 1. Myocardial perfusion imaging: Small to moderate sized, moderate severity, reversible perfusion defect in the apex. 2. Cardiac catherization: 50% distal main left coronary stenosis (near the origin of circumflex and LAD), followed by 75% stenosis of proximal LAD. |
| DDx: Not applicable |
| Diagnosis: 1. Myocardial perfusion: Mild to moderate sized apical ischemia of moderate severity. 2. Cardiac catherization: 50% stenosis near left main coronary artery bifurcation, 75% stenosis in proximal LAD. Coronary bypass surgery recommended, given the stenosis near the origins of LAD and circumflex. |
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General Discussion: This case is an example of hemodynamically significant stenosis in the left main and proximal LAD with only a small distal territory ischemia on the myocardial perfusion imaging. The actual degree of stenosis can be more severe and more proximal than the observed ischemic territory seen on the myocardial perfusion imaging. The converse, (i.e. seeing more significant ischemia / territory on myocardial perfusion imaging than corresponding angiographic stenosis), can also be seen in some cases (see Case 105214). This patient was treated with a LIMA to LAD bypass as well as a radial to obtuse marginal bypass. He was discharged 1 week following the bypass surgery in good condition. |
| Comments: No comments posted. |
| Additional Details:
Case Number: 105494 The reader is fully responsible for confirming the accuracy of this content. |
