Rosencher Julien, Marques Cindy, Raouhal Ghilas, Cacoub Patrice
Cardiology Department, Groupe Hospitalier Privé Ambroise Paré-Hartmann, 48 ter bld Victor Hugo, Neuilly-sur-Seine 92200, France.
Sorbonne Université, Hôpital Pitié-Salpêtrière (AP-HP), 83 boulevard de l'Hopital, Paris 75013, France.
Eur Heart J Case Rep. 2025 Apr 15;9(4):ytaf155. doi: 10.1093/ehjcr/ytaf155. eCollection 2025 Apr.
Coronary artery disease (CAD) secondary to coronary arteritis (CA) is a rare and challenging condition to diagnose, often resulting in poor clinical outcomes. Conventional coronary angiography lacks the sensitivity to identify inflammatory causes, leading to underdiagnosis and inappropriate treatment. Advanced imaging techniques, particularly cardiac computed tomography angiography (CCTA), appear to be invaluable tools to correctly identifying CA as the underlying cause of atypical CAD.
We describe the case of a 74 year old patient without traditional risk factor who presented with chest pain, a positive clinical and electrical stress test. Given the highly atypical form of CAD on CCTA characterized by a diffuse, circumferential thickening of coronary arteries, an inflammatory cause was suspected. Large vessel vasculitis was confirmed by fluorodeoxyglucose-positron emission tomography scan (FDG-PET). Treatment with aspirin, statins, beta-blockers, and corticosteroids resulted in symptom resolution, with subsequent imaging showing regression of both vessels hypermetabolism and coronary arterial thickening, thus avoiding the need for coronary revascularization.
This case highlights the importance of multimodal imaging, particularly CCTA and FDG-PET, in diagnosing CA in patients with atypical CAD presentations. Early recognition and management of active inflammation can prevent unnecessary revascularization and improve clinical outcomes.
继发于冠状动脉炎（CA）的冠状动脉疾病（CAD）是一种罕见且诊断具有挑战性的疾病，常常导致不良的临床结局。传统冠状动脉造影缺乏识别炎症病因的敏感性，导致诊断不足和不恰当的治疗。先进的成像技术，尤其是心脏计算机断层扫描血管造影（CCTA），似乎是正确识别CA作为非典型CAD潜在病因的宝贵工具。
我们描述了一名74岁无传统危险因素的患者，其出现胸痛，临床和心电图负荷试验呈阳性。鉴于CCTA上CAD的高度非典型表现为冠状动脉弥漫性、环形增厚，怀疑为炎症病因。氟脱氧葡萄糖-正电子发射断层扫描（FDG-PET）证实为大血管血管炎。使用阿司匹林、他汀类药物、β受体阻滞剂和皮质类固醇治疗后症状缓解，随后的影像学检查显示血管高代谢和冠状动脉增厚均消退，从而避免了冠状动脉血运重建的需要。
该病例强调了多模态成像，尤其是CCTA和FDG-PET，在诊断非典型CAD表现患者的CA中的重要性。早期识别和管理活动性炎症可预防不必要的血运重建并改善临床结局。
