Evidence and characterization of occlusive coronary artery thrombus by multislice-computed tomography

In recent years, multislice-computed tomography has been shown to be a reliable tool for non-invasive assessment of atherosclerotic coronary artery plaque, particularly with regard to the location, dimension, morphology, severity and composition of the lesion. In this report, we describe a case of acute coronary syndrome in which multislice-computed tomography showed evidence of a coronary occluding thrombus which probably dissolved spontaneously, as indicated by emergency coronary angiography. This was made possible by analyzing retrospectively multislice-computed tomography density values at the site of the occluded vessel, which were ∼50 Hounsfield Units, and comparing them with subsequent coronary angiography which revealed an open coronary vessel. Although this report needs to be confirmed by more extensive studies, it would seem to indicate that acute coronary syndrome frequently occurs as a consequence of the disruption of slightly occluding, mainly fibro-lipidic coronary plaques. We conclude that density values of ∼50 Hounsfield Units detected by multislice-computed tomography at the site of an occluded vessel should be interpreted in the first instance as a thrombus of recent formation.