[Cardiac anatomy and the radiologist]

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Thoracic computed tomography (CT) scans are commonly used to evaluate various cardiopulmonary conditions.
• Routine chest CTs are often performed without electrocardiogram (EKG)-gating, which can limit the visualization of dynamic cardiac structures.
• Aortic dissection is a critical condition requiring prompt diagnosis via imaging.

Observation:

• A case is presented where a myocardial infarction was incidentally discovered.
• The infarction was attributed to an occlusion in the left anterior descending artery.
• The diagnosis was made on a standard chest CT scan obtained to rule out aortic dissection.

Findings:

• Left anterior descending artery (LAD) occlusion can be identified on non-EKG-gated chest CT.
• Incidental findings of coronary artery disease are possible during thoracic CT evaluations.
• The study demonstrates the potential for detecting significant coronary events with standard CT protocols.

Implications:

• Radiologists should meticulously evaluate the heart and coronary arteries in all thoracic CT scans.
• EKG-gating is not always necessary for identifying acute coronary events like myocardial infarction.
• This case emphasizes the value of comprehensive review of imaging studies beyond the primary indication.