CTICasesRadiation-Induced Coronary Artery Stenosis
Imaging findings
A young patient with recurrent thymoma and Good syndrome (thymoma-associated hypogammaglobulinemia, with chronic bronchial thickening and tree-in-bud nodularity) received chest radiation, then re-radiation. Months later, coronary CTA for chest pain shows multiple severe LAD lesions, a tight diagonal lesion, and an absent/occluded obtuse marginal branch within the radiation field, with a pristine RCA outside the field. Invasive catheterization initially underestimated the obtuse marginal, later confirmed totally occluded.
Key takeaways
Radiation to the chest can cause severe premature coronary artery stenosis confined to the treatment field, sparing vessels outside it, even in a young patient. This case also illustrates that catheterization, though the imaging gold standard, is still an interpreted imaging test and can underestimate disease, with CT here better delineating the occluded obtuse marginal.
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