CTICasesSpontaneous Left Anterior Descending Artery (LAD) Dissection
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Imaging findings
Coronary CTA showed stents in the mid and distal LAD, with irregular outpouchings from the LAD and a large area of hypodensity extending around the LAD to the stent level. Her heart was massively dilated with a severely dilated heart and an EF of 15%. A catheterization angiogram still showed areas of filling of the false lumen, corresponding to the contrast outpouchings seen on CTA. Short axis views demonstrated narrowing of the LAD by an extensive thrombosed false lumen surrounding the vessel.
Key takeaways
This is an extremely rare condition, with almost 100% mortality, but this woman survived. Spontaneous LAD dissection is most commonly seen in women who are postpartum or peripartum; this patient was 8 months pregnant. The etiology is thought to be related to hormone fluctuations, though it's also described in weightlifters or people performing intense strenuous exercise.
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