The radiographic appearance of coronary artery dissection: a decision-making dilemma.

The appearance of acute iatrogenic dissection of the coronary arteries during coronary angiography is described in five patients. Specific signs of dissection include: 1) initimal flap, 2) delayed flow, 3) loss of side branches, 4) periostial contrast "puddling," and 5) unusually small size coronary artery with atypical smooth walls. Recognition of the radiographic patterns of this complication should permit distinction from coronary spasm, thrombosis, and embolization. Recent advent of alternate forms of therapy (streptokinase infusion, angioplasty) makes it imperative to precisely diagnose the dissection to avoid possible catastrophic results.