CTICasesLateral Costal Artery Embolization Coils in a LIMA Bypass Patient
Imaging findings
Chest radiograph demonstrates small metallic coils projected along the left chest wall that are stable over serial examinations spanning a decade. On review of historical records, the patient had a prior LIMA coronary artery bypass graft and subsequently underwent intentional embolization of the lateral costal artery, which communicates with the LIMA and can cause steal phenomenon. CT confirms the embolization coils within the lateral costal artery. A patent right-sided lateral costal artery is also identified.
Key takeaways
The lateral costal artery is an anatomical variant that communicates with the LIMA and can cause coronary steal phenomenon in patients who have undergone LIMA bypass grafting by diverting blood away from the bypass territory. Embolization of the lateral costal artery is an intentional therapeutic procedure performed to eliminate this steal, and the resulting coils can persist on chest radiographs for many years and be mistaken for a detached pacemaker lead or other hardware. The stable appearance across serial studies and the specific location along the left chest wall lateral to the LIMA path are key to recognition.
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