CTICasesSpontaneous Coronary Artery Dissection
[...]. Spontaneous Coronary Artery Dissection. CTICases. Published September 19, 2026. https://cticases.com/c/kwewe
Imaging findings
A 30-year-old woman developed acute chest pain while using the restroom and presented with elevated troponin and ST-segment changes. Coronary CT angiography showed a focal defect in the left anterior descending artery with occlusion of some of its distal branches, consistent with spontaneous coronary artery dissection. On adjusted window settings the subendocardium in that territory appeared slightly hypoenhancing, supported by apical ballooning of the ventricle and wall motion abnormality on echocardiography. She was a daily vaper and marijuana user. She went directly to the catheterization laboratory, where the segment was stented.
Key takeaways
Spontaneous coronary artery dissection is one of the most common causes of acute myocardial infarction in young women and should be considered whenever a young woman presents with ischemic-sounding chest pain. It classically occurs during or shortly after pregnancy, when hemodynamic changes are greatest. Hypertension is a major risk factor, and nicotine and marijuana may contribute, although evidence for a direct link with vaping is lacking. Subtle subendocardial hypoenhancement on CT can be artifactual, but when it matches a wall motion abnormality and apical ballooning in the territory of the dissected vessel it is likely real.
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