Spontaneous coronary artery spasm accidentally detected by 320-row multi-detector computed tomography.

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.>.