CASE 5329 Published on 23.10.2006
0

Myocardial bridging on MDCT

Section

Cardiovascular

Case Type

Clinical Cases

Authors

Murat Canyigit, Tuncay Hazirolan. Hacettepe University Hospitals, 06100, Sihhiye, Ankara/TURKEY. Tel:+90 312 3051188 Fax: +90 312 3112145

Connected authors
Patient

49 years, male

Download as PDF Print Show related cases Notify admin
Clinical History
49-year-old male with diabetes mellitus and atipic chest pain.
Imaging Findings
49-year-old male with diabetes mellitus and atipic chest pain who underwent MDCT coronary angiography for evaluation of coronary artery atherosclerotic disease.
Discussion
MDCT demostrated myocardial bridging (MB) on the middle segment of the LAD. Depth and length of the MB was 4.6 mm and 50.9 mm, respectively. A calcific atherosclerotic plaque was also seen just proximal to tunneled segment. MB is a common inborn coronary anomaly, characterized by muscle overlying a segment of a coronary artery, which should flow epicardially. The vascular segment located within the myocardium is called “tunneled artery”. The artery most commonly involved is the left anterior descending coronary artery, and most muscle bridges occur between the proximal third and middle third portions of the vessel. Despite the fact that it is a congenital anomaly, symptoms usually do not develop before the third decade. MB of the coronary arteries are detected in 15% to 85% of autopsy series and in 0.5% to 16% angiographic studies. Although, MB has been considered a benign condition, some complications such as myocardial ischemia, myocardial infarction, myocardial stunning, left ventricular dysfunction, ventricular septal rupture, acute allograft failure in heart transplant, paroxysmal AV blockage, ventricular tachycardia and sudden cardiac death have been reported. Atherosclerotic changes were seen just proximal to tunneled artery more than within or distal to it. The current gold standard for diagnosing myocardial bridges is conventional coronary angiography, which shows the typical "milking effect" and a "step down–step up" phenomenon induced by systolic compression of the tunneled segment. The diagnosis of MB can also be made using intravascular ultrasound (IVUS), and intracoronary Doppler, which can visualize and quantify morphological and functional features of MB. MDCT is a recently used modality in diagnosis of MB. The advantage of MDCT over coronary angiography and IVUS is non-invasive identification of vulnerable atherosclerotic lesions, coronary artery anomalies, pericardium and myocardium pathologies, coronary artery bypass and stent patency and direct demonstration of the course of the artery through the myocardium as well as MB.
Differential Diagnosis List
Myocardial bridging
Final Diagnosis
Myocardial bridging
Case information
URL: https://www.eurorad.org/case/5329
DOI: 10.1594/EURORAD/CASE.5329
ISSN: 1563-4086
Figure 1

Figure 1

Figure 1
Short axis MPR image shows the bridge on the middle segment of the LAD (arrow) with a depth of 4.6 mm in which the presence of muscle is seen clearly.
Figure 2

Figure 2

Figure 2
Curved MPR images (A, B) show a long segment in middle part of left descending artery (arrows) encased by myocardium. A calcific atherosclerotic plaque (arrowhead) is also seen just proximal to myocardial bridging.
Figure 2
Curved MPR images (A, B) show a long segment in middle part of left descending artery (arrows) encased by myocardium. A calcific atherosclerotic plaque (arrowhead) is also seen just proximal to myocardial bridging.