Tumor-like coronary atheroma: a modern coronary evaluation with a historical perspective

The concept that atherosclerotic disease could be a form of neoplasm has been proposed in the medical literature for centuries, yet few modern cardiologists or pathologists describe atherosclerotic plaques as having the appearance of tumors. Although atherosclerosis is now considered to be an inflammatory disease, parallels between the pathophysiologic courses of atherosclerosis and neoplasia have been described since the 19th century. Current research is increasingly focused on mechanisms common to both diseases.Herein, we present the case of a 70-year-old man with a tumor-like coronary atheroma that was diagnosed on computed tomographic coronary angiography and confirmed with the use of intravascular ultrasound. However, the large plaque was not apparent on conventional invasive angiography. This case serves as a reminder of the limitations of invasive angiography and of the superiority of both computed tomographic coronary angiography and intravascular ultrasound in identifying and quantifying coronary plaque. We discuss our interpretation of the patient's lesion and review various theories of atherogenesis.