Heavy Coronary Calcium Mimicking In-Stent Restenosis

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. A 49-year-old man was referred for the evaluation of ischemic heart disease. He was told having calcified coronary artery on low-dose chest computed tomography (CT) checked for routine health screening. He denied past coronary intervention and he was healthy without smoking. Treadmill exercise echocardiography showed normal findings without post-exercise wall motion abnormalities. Multislice scanner with 64-row multidetector CT (MDCT) (Brilliance, Philips, Netherlands) revealed heavily calcified coronary arteries with very high calcium score (Agatston unit 1039.7) (Fig. 1, white arrows). Right coronary artery also had high calcium burden with linear calcium mimicking coronary stent (Fig. 1B, white arrow), which was misinterpreted as in-stent restenosis. Coronary angiography was not performed thereafter. MDCT provides non-invasive imaging of coronary anatomy and is widely used in the various clinical settings.1-3) However, coronary calcium can reduce its diagnostic value and has various features. Careful history taking and understanding for this various characteristics of coronary calcium on MDCT may give chance to avoid misinterpretation.