A Novel Cause of Acute Coronary Syndrome Due to Dynamic Extrinsic Coronary Artery Compression by a Rib Exostosis: Multimodality Imaging Diagnosis

Jonathan C L Rodrigues, Helen C Mathias, Stephen M Lyen, Elisa Mcalindon, Chiara Bucciarelli-Ducci, Timothy J P Batchelor, Mark C K Hamilton, Nathan E Manghat

Research output: Contribution to journalArticle (Academic Journal)peer-review

6 Citations (Scopus)

Abstract

We report a case of acute coronary syndrome secondary to intermittent extrinsic compression of the left anterior descending coronary artery by inward-pointing rib exostosis in an 18-year-old woman during forceful repeated expiration in labour. The diagnosis was achieved using multimodality noninvasive cardiac imaging. In particular, we demonstrated the novel role of expiratory-phase cardiac computed tomography in confirming the anatomical relationship of the bony exostosis to the left anterior descending coronary artery. The case reminds us the heart and mediastinum move dynamically, relative to the bony thorax, throughout the respiratory cycle, and that changes in cardiac physiology in pregnancy may become pathological.

Original languageEnglish
Pages (from-to)1303.e9-1303.e11
JournalInternational Journal of Cardiology
Volume31
Issue number10
DOIs
Publication statusPublished - Oct 2015

Keywords

  • Acute Coronary Syndrome
  • Adolescent
  • Coronary Angiography
  • Coronary Vessels
  • Delivery, Obstetric
  • Exostoses
  • Exostoses, Multiple Hereditary
  • Female
  • Humans
  • Magnetic Resonance Imaging, Cine
  • Multimodal Imaging
  • Pregnancy
  • Pregnancy Complications, Cardiovascular
  • Pressure
  • Pulmonary Artery
  • Ribs
  • Thoracic Surgery, Video-Assisted
  • Tomography, X-Ray Computed
  • Treatment Outcome

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