ECG and thallium imaging abnormalities with normal coronary angiogram in a male flight surgeon

Coronary artery disease and cardiac anomalies have the potential to cause sudden incapacitation in the flight environment with potentially disastrous consequences. Flight surgeons are responsible for screening for these potential diseases. We report a case of a healthy, active, asymptomatic U.S. flight surgeon returning for duty who demonstrated an abnormal ECG, graded exercise test, and thallium imaging. He was ultimately referred for cardiac catheterization that revealed normal coronary arteries. We discuss the sensitivity of non-invasive screening studies in healthy young individuals and potential causes of "false-positive" thallium imaging.