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The role of intravascular ultrasound scan and thin-sliced coronary computed tomography angiography in diagnosing aortic dissection causing acute myocardial infarction
Daisuke Nagatomo1, Daizaburo Yanagi1, Takeshi Serikawa2, Masanori Okabe3, Yusuke Yamamoto4
1MD, Resident Physician, Department of Cardiology, Cardiovascular and Aortic Center of Saiseikai Fukuoka General Hospital, Fukuoka, Japan.
2MD, Manager of the Catheterization Laboratory, Department of Cardiology, Cardiovascular and Aortic Center of Saiseikai Fukuoka General Hospital, Fukuoka, Japan.
3MD, Assistant Director, Department of Cardiology, Cardiovascular and Aortic Center of Saiseikai Fukuoka General Hospital, Fukuoka, Japan.
4MD, Director, Department of Cardiology, Cardiovascular and Aortic Center of Saiseikai Fukuoka General Hospital, Fukuoka, Japan.

doi:10.5348/ijcri-201462-CR-10373

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How to cite this article
Nagatomo D, Yanagi D, Serikawa T, Okabe M, Yamamoto Y. The role of intravascular ultrasound scan and thin-sliced coronary computed tomography angiography in diagnosing aortic dissection causing acute myocardial infarction. International Journal of Case Reports and Images 2014;5(4):302–306.


Abstract
Introduction: Acute aortic dissection is a disease of high mortality. The symptoms may mimic other conditions and misdiagnosed, such as acute coronary syndrome, coronary involvement complicates the clinical scenario and increases mortality.
Case Report: We herein report a case of an acute myocardial infarction caused by acute aortic dissection. Without noticing the aortic dissection, we performed emergent coronary angiography, which showed severe stenosis of the proximal right coronary artery. Intravascular ultrasound scan led us to suspect aortic dissection. However, we performed balloon angioplasty because the patient's hemodynamic status was unstable. ECG-gated coronary computed tomography angiography provided a definitive diagnosis, and the patient underwent successful surgical repair of the aortic dissection.
Conclusion: Acute coronary syndrome associated with acute aortic dissection is not rare. However, the management of these conditions depends on the details of each case. This case demonstrates the difficulty of treating such cases in the real world. Herein, we describe educational imaging findings and briefly discuss the management of cases involving acute coronary syndrome associated with acute aortic dissection.

Keywords: Coronary computed tomography angiography, Acute aortic dissection, Acute myocardial infarction


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Author Contributions
Daisuke Nagatomo – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Daizaburo Yanagi – Conception and design, Acquisition of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Takeshi Serikawa – Conception and design, Acquisition of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Masanori Okabe – Conception and design, Critical revision of the article, Final approval of the version to be published
Yusuke Yamamoto – Conception and design, Drafting the article, Critical revision of the article, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© Daisuke Nagatomo et al. 2014; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.)



About The Authors

Nagatomo is Resident Physician, at the department of Cardiology, Cardiovascular and Aortic Center of Saiseikai Fukuoka General Hospital, Fukuoka, Japan. His area of interest include evaluation of cardiac function and coronary intervention. He intends to pursue a fellowship in cardiology after completing his residency.



Yanagi is chief resident, at the department of Cardiology, Cardiovascular and Aortic Center of Saiseikai Fukuoka General Hospital, Fukuoka, Japan. His area of interest include coronary intervention and peripheral artery disease and published some papers in J Cardiol. 2007;49:63, and 2008;51:89.



Serikawa is a general manager at the Department of Cardiology Cardiovascular and Aortic Center of Saiseikai Fukuoka General Hospital, Fukuoka Japan. His speciality is coronary intervention(complex PCI and OCT examination). He obtained doctor of Philosophy. He published some papers about coronary intervention and coronary risk factors in J Interv Cardiol. 2011;24:165, and J Cardiol. 2014;63:35.



Okabe is Director, at the department of Cardiology, Cardiovascular and Aortic Center of Saiseikai Fukuoka General Hospital, Fukuoka, Japan. His area of interest include myocardial disease and heart failure, and wrote several papers published in Jpn Circ J. 1995;59:49, 1997;61:78, 1999;63:485, Br Heart J. 1991;65:317, Am Heart J. 1992;123:128, Jpn Heart J. 1993;34:121, and Circulation 1997;96:22.



Yamamoto (MD and PhD) is now heading Cardiovascular and Aortic Center of Saiseikai Fukuoka General Hospital, Fukuoka, Japan. He is also clinical professor of Kyushu University (Cardiology), Fukuoka, Japan. He researched the pathophysiology of coronary artery spasm at Kyushu University and published several papers in Circulation 1986;74:826, Circulation Research 1987;60:113, 1987;61:772 and JACC 1989;63:33. Then, he studied Cardiac PET in Hammersmith Hospital of London University and wrote some papers in J Nucl Med 1991;32:2169, J Physiol 1992;446:219, Circulation 1992;86:167, 1992;86:1738, 1996;94:792 and 1996;94:808. His present interest is the relationship between ischemic heart disease and environmental issues, especially air pollution.