Circumflex masquerade

J. Calem-Grunat, D. Sklar, Javier Villanueva-Meyer, I. Mena

Research output: Contribution to journalArticle

Abstract

A 62-year-old man with a history of hypertension, borderline hypercholesterolemia, and unstable angina underwent a cardiac catheterization that revealed a 100% occlusion of the left anterior descending artery with poor distal filling. The left circumflex was an abnormal appearing large vessel, and the distal branch demonstrated a 100% proximal occlusion. The right coronary artery was totally occluded, and the posterior descending artery filled from left to right via collateral flow. The patient experienced several bleeding complications from intravenous heparin and was transferred to our institution for urgent revascularization. Coronary artery bypass graft times four was performed and included reverse saphenous vein graft to the LAD, first diagonal branch, distal left circumflex, and PDA. Approximately 22 months later, the patient began experiencing a burning sensation in the anterior part of the neck after riding a bicycle for 1 mile. Stress Tc-99m MIBI was requested, and the patient stressed via the standard Bruce Protocol. Acquisition was performed in a 180° rotation from 45° RPO to 45° LAO. SPECT images at rest revealed a septal infarct and good perfusion to the remaining myocardium. Given the patient's known situs inversus, the extensive infarction, apparently within the lateral wall, corresponds to the interventricular septum in this complete dextrocardia. For the clinician unaware of this anatomic variant, the LAD territory would be misconstrued as left circumflex pathology.

Original languageEnglish (US)
Number of pages1
JournalClinical Nuclear Medicine
Volume17
Issue number11
DOIs
StatePublished - Nov 26 1992
Externally publishedYes

Fingerprint

Arteries
Dextrocardia
Situs Inversus
Transplants
Technetium Tc 99m Sestamibi
Unstable Angina
Saphenous Vein
Cardiac Catheterization
Hypercholesterolemia
Single-Photon Emission-Computed Tomography
Coronary Artery Bypass
Infarction
Heparin
Coronary Vessels
Myocardium
Neck
Perfusion
Pathology
Hemorrhage
Hypertension

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Calem-Grunat, J., Sklar, D., Villanueva-Meyer, J., & Mena, I. (1992). Circumflex masquerade. Clinical Nuclear Medicine, 17(11). https://doi.org/10.1097/00003072-199211000-00013

Circumflex masquerade. / Calem-Grunat, J.; Sklar, D.; Villanueva-Meyer, Javier; Mena, I.

In: Clinical Nuclear Medicine, Vol. 17, No. 11, 26.11.1992.

Research output: Contribution to journalArticle

Calem-Grunat, J, Sklar, D, Villanueva-Meyer, J & Mena, I 1992, 'Circumflex masquerade', Clinical Nuclear Medicine, vol. 17, no. 11. https://doi.org/10.1097/00003072-199211000-00013
Calem-Grunat J, Sklar D, Villanueva-Meyer J, Mena I. Circumflex masquerade. Clinical Nuclear Medicine. 1992 Nov 26;17(11). https://doi.org/10.1097/00003072-199211000-00013
Calem-Grunat, J. ; Sklar, D. ; Villanueva-Meyer, Javier ; Mena, I. / Circumflex masquerade. In: Clinical Nuclear Medicine. 1992 ; Vol. 17, No. 11.
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