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BMJ Case Reports 2009; doi:10.1136/bcr.08.2008.0776
  • Rare disease

Differential diagnosis of non-atherosclerotic left main coronary artery stenosis

  1. Michael Gotzmann1,
  2. Waldemar Bojara1,
  3. Alfried Germing1,
  4. Andreas Mügge1,
  5. Axel Laczkovics2,
  6. Christine Thiessen3,
  7. Andrea Tannapfel4,
  8. Michael Lindstaedt1
  1. 1
    Berufsgenossenschaftliche Universitätsklinik Bergmannsheil, Medizinische Klinik II,Kardiologie und Angiologie, Bürkle-de-la-Camp-Platz 1, Bochum, 44789, Germany
  2. 2
    Berufsgenossenschaftliche Universitätsklinik Bergmannsheil, Clinic for Cardiothoracic Surgery, Bürkle-de-la-Camp-Platz 1, Bochum, 44789, Germany
  3. 3
    Johannes Hospital Dortmund, Department of Medicine, Hematology and Oncology, Johannesstraße 9-17, Dortmund, 44137, Germany
  4. 4
    Berufsgenossenschaftliche Universitätsklinik Bergmannsheil, Institute of Pathology, Bürkle-de-la-Camp-Platz 1, Bochum, 44789, Germany
  1. michael_gotzmann{at}web.de
  • Published 2 March 2009

Summary

A left main coronary artery (LMCA) stenosis without any atherosclerotic changes elsewhere in the coronary artery tree is a rare finding, and some uncommon reasons for luminal narrowing should be considered. An unusual case of non-atherosclerotic LMCA stenosis is reported.

A middle-aged patient presented with acute myocardial infarction. An immediate coronary angiography was ordered and revealed a subtotal mid LMCA stenosis. A drug-eluting stent was successfully implanted in the LMCA.

Operative revascularisation was recommended. Routine surgery was performed and surprisingly revealed an extended mass of a mediastinal tumour surrounding the aortic root. Histopathological examination of the tumour revealed a poorly differentiated squamous cell carcinoma.

Postoperatively, the patient was treated with chemotherapy (carboplatin and docetaxel). Five years after the first admission to our hospital, the patient died as a result of ventricular fibrillation.

The differential diagnosis of non-atherosclerotic LMCA stenoses is discussed.

Footnotes

  • Competing interests: none.

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