CTICasesAcute LAD Occlusion with Zero Calcium Score
Imaging findings
Coronary CTA in a patient in their 50s with a calcium score of zero shows myocardial bridging of the LAD and a completely occluded proximal LAD, with no calcified plaque. Vital signs at the time of the scan showed the systolic blood pressure falling to 60 with bradycardia. No atrial septal defect, PFO, left atrial appendage filling defect, or mitral vegetation was identified.
Key takeaways
A zero calcium score does not exclude acute coronary occlusion, as acute plaque rupture with thrombus can completely occlude a vessel in a patient with no calcified plaque. The absence of distal collateral vessels supports an acute rather than chronic occlusion, and the patient did well after emergent stenting. This case argues for including a non-contrast calcium series and remaining alert to acute occlusion when imaging patients with chest pain, even without calcium.
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