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Figure 4


Fig. 1D —63-year-old man presenting to emergency department with 10 minutes of exercise-induced substernal chest pain radiating to his left arm 2.5 hours ago. Initial troponin and creatine kinase, myocardial bound tests were negative, and ECG showed T-wave inversions in V1 to V3; otherwise unremarkable ECG. 64-MDCT was performed 3 hours after emergency department presentation. RCA = right coronary artery, LAD = left anterior descending artery, LCX = left circumflex coronary artery, PDA = posterior descending artery. Magnified view of distal RCA segment seen in C shows significant luminal narrowing (> 50%) compared with proximal and distal reference (dashed arrows), approximately 2 cm proximal to bifurcation of PDA and posterior left ventricular branch. In this area, large excentric noncalcified plaque (arrowhead) causing stenosis is seen (arrow).