CTICasesSpontaneous Coronary Artery Dissection
Imaging findings
A young postpartum, breastfeeding woman presented with severe chest pain and a markedly elevated troponin. Cardiac CT shows a long-segment narrowing of a coronary artery with surrounding eccentric soft tissue (intramural hematoma) and the vessel nearly disappearing then reappearing, with no atherosclerotic disease elsewhere. There is hypoattenuation and thinning along the LAD territory distal to the occlusive segment with severe hypokinesis, indicating infarction. A second SCAD case occurred the same period.
Key takeaways
Spontaneous coronary artery dissection typically affects young women, classically peripartum or postpartum, and often appears as a long-segment narrowing from intramural hematoma compressing the vessel (occasionally with a visible dissection flap) in otherwise normal coronaries. It can cause infarction and sudden death; management is often conservative (beta blockade, anticoagulation) with stenting reserved for occlusion, and patients are subsequently evaluated for fibromuscular dysplasia given the strong association.
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