CTICasesCoronary Artery Stenosis and Myocardial Infarction
Imaging findings
Coronary CT angiogram demonstrates extensive calcified and non-calcified plaque disease throughout the coronary tree, including a severe, initially overlooked stenosis at the bifurcation of the circumflex coronary artery. A follow-up cardiac MRI obtained months later after a non-ST-elevation myocardial infarction (NSTEMI) shows a transmural lateral wall myocardial infarction with adjacent focal pericardial enhancement and thickening.
Key takeaways
Missed significant coronary stenoses, particularly in complex locations like the circumflex bifurcation, can lead to subsequent myocardial infarction. The presence of focal pericardial enhancement adjacent to the infarcted myocardium indicates localized post-infarct pericarditis, which can help date the event.
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