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A 48-year-old man presented at the emergency department with a short episode of chest pain. His medical history was unremarkable. Besides smoking, there were no risk factors for coronary artery disease. The ECG and biomarker levels at presentation were normal.
As part of a quick rule out protocol, coronary CT angiography (CCTA) was performed. The scan showed multiple calcifications in the left anterior descending (LAD), left circumflex artery (LCX) and including a partially calcified plaque in the proximal LAD. The distal part of this plaque showed a very low attenuation profile with evidence of intraplaque dye penetration. This pattern of a ring-like enhancement is considered to be suggestive of an ulcerated plaque (figure 1A). In addition, a severe non-calcified …
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