Impact of Cardiac Computed Tomographic Angiography Findings on Planning of Cancer Therapy in Patients with Concomitant Structural Heart Disease
Figure 3
61-year-old male with aggressive large B-cell lymphoma developed chest pain after the first cycle of chemotherapy. Electrocardiogram and cardiac enzyme measurements are consistent with NSTEMI. Echocardiography demonstrated a decrease in left ventricular ejection fraction from a normal baseline to 40%. Due to postchemotherapy thrombocytopenia and leucopenia, an invasive coronary angiogram could not be obtained. Based on the coronary CT angiogram results, further chemotherapy was placed on hold. Invasive coronary angiography was performed after recovery of blood counts, followed by coronary artery bypass grafting. Two weeks later, the patient restarted chemotherapy. (a) Curved reformat view of the right coronary artery shows scattered calcific and noncalcified atherosclerotic plaque (white arrowheads) with possible occlusion (arrow) near the junction of the mid and distal segments. The conus branch origin (black arrowhead) is identified. (b) Curved reformat view of the left anterior descending artery (LAD) shows calcific and noncalcified atherosclerotic plaque (white arrowheads) in the proximal LAD, with focal near occlusion (arrow) of the LAD at the origin of the first diagonal (D1). Also noted is a mixed ostial left main artery plaque (asterisk). (c) Curved reformat view of the circumflex coronary artery (LCx) and proximal LAD shows calcific and noncalcified atherosclerotic plaque (arrowheads) in the proximal segments of both vessels. The LCx appears occluded at the junction of the proximal and middle segments (arrow). The ostial left main artery plaque in this projection appears noncalcified and significantly stenotic (asterisk). LA = left atrium. LV = left ventricle. RA = right atrium. RV = right ventricle. Ao = Aortic root. (d) Invasive angiogram demonstrating same findings with good correlation. The left main coronary is significantly stenosed (asterisk). The left anterior descending artery shows multiple high grade stenoses (thin arrow) and the left circumflex artery is occluded (thick arrow).
