A 64-year-old woman was introduced to our hospital suspected of having
angina pectoris. A 12-lead electrocardiogram showed negative T wave in inferior leads. An echocardiography revealed no abnormality. In 320-row multi-detector computed tomography (MDCT), a severe narrowing of the right coronary artery was detected with collateral vessels between the distal portion of the obstructed right coronary artery and the left anterior descending artery. Coronary angiography showed no
stenosis of the right coronary artery and non-obstructive plaques in the left coronary artery. To provoke
coronary artery spasm,
acetylcholine was infused into the left coronary artery. But, no narrowing was inducible in the left coronary artery. After that, a
spasm of the right coronary artery was observed without the injection of
acetylcholine into the right coronary artery. The
spasm was located in the same site as the narrowing on MDCT imaging. A
calcium channel antagonist (
benidipine hydrochloride 8 mg/day) and a
nitrate (
isosorbide dinitrate 80 mg) were effective for
coronary artery spasm. <Learning objective: Multi-detector computed tomography (MDCT) imaging is useful for examining
coronary artery disease. In addition to evaluating coronary organic
stenosis, 320-row MDCT could detect spontaneous
coronary artery spasm. Although
coronary artery spasm has to be taken into account, intracoronary injection of
acetylcholine is necessary to diagnose
coronary artery spasm.>.