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Acute coronary syndrome in a patient with a large inter-communicating coronary vascular malformation: imaging with 320-slice CT
  1. Wai-ee Thai,
  2. Ian T Meredith,
  3. Philip M Mottram
  1. Monash Cardiovascular Research Centre, MonashHEART, Southern Health & Department of Medicine (MMC), Monash University, Melbourne, Australia
  1. Correspondence to Dr Wai-ee Thai, Non-Invasive Cardiac Imaging Fellow, Monash Heart, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia; waiee{at}

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A 49-year-old woman presented with central chest discomfort associated with anterior T-wave inversion and raised troponin I concentrations consistent with an acute coronary syndrome. Invasive coronary angiography revealed only minor non-obstructive coronary disease; however, a large poorly defined vascular malformation was identified. Multidetector (320-slice) cardiac CT defined a large left-sided arterial vascular malformation with multiple fistulous channels between the left anterior descending and right coronary arteries (figure 1), and a single point of drainage into the proximal pulmonary artery. Echocardiography revealed normal left heart chamber volumes and pulmonary artery systolic pressure, consistent with a non-haemodynamically significant shunt. The acute coronary syndrome was postulated to be secondary to an embolic source from the arterial vascular malformation. The patient was …

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The use of 320-slice cardiac CT has been approved for appropriate patients by the Southern Health Ethics Committee at Monash Medical Centre. The patient consented for angiography and cardiac CT as per usual medical protocol for Southern Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.