Case of the Month, June 2017

Our Imaging Case of the Month is presented as a part of the Imaging Department's residency teaching program. Each month a resident collaborates with one of our attending imaging physicians to present an interesting case to the Cedars-Sinai medical community. The case is used to teach both imaging and other residents at Cedars-Sinai. Below is the current Case of the Month.

Submitted by Michael Pakdaman, MD, and Thomas J. Learch, MD

History of Present Illness

An 86-year-old male patient with history of hypertension, hyperlipidemia, chronic diastolic heart failure, and coronary artery disease. His pertinent surgical history includes coronary revascularization with metal stents to the circumflex and ramus in 2014, angioplasty to a diagonal branch of the LAD in 1989, and drug-eluting stent placement in left circumflex and ramus vessels in May 2016.

The patient had complained of longstanding exertional chest pain and dyspnea. A transthoracic echocardiogram revealed an aortic valve area of 0.5 cm2 consistent with severe aortic valve stenosis.

The patient was deemed unfit for surgical management of aortic stenosis and was planned for transcatheter aortic valve replacement (TAVR). A preoperative cardiac CT was performed.

Gated CT angiography demonstrates severe aortic stenosis with large calcification on the left coronary cusp.


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