Nebulous

Abstract

To the Editor: We read with some concern the report by Li et al1 referring to electron beam angiography of anomalous coronary arteries. Two pictures are presented of a case diagnosed as anomalous origin of the left anterior descending artery (LAD) “from the pulmonary artery” and of the circumflex (Cx) “from the right coronary artery.” We appreciated the colorful images (even though the blue aorta would have appeared better in red), but could not refrain from noticing the following. 1. The images do not prove the origin of the LAD from the pulmonary artery. Instead, one can only say that the LAD is ectatic, and is adjacent to the pulmonary trunk (a normal course). There is no evidence, in the images provided, that the LAD has its origin from the pulmonary artery. 2. The Cx is not identified in Figure 1 and apparently is mislabeled in Figure 2. Indeed, it appears that the tortuous vessel in Figure 1 is the same right coronary artery that is labeled “Cx” in Figure 2. The Cx (labeled “RCA”) in Figure 2 is most likely a coronary vein. A left circumflex coronary artery coursing within the right atrioventricular groove, alongside a normally positioned RCA, would be a heretofore never seen (nor described) coronary anomaly. Was traditional angiography performed in this patient to confirm these findings? Our reason for sending this note is to caution against the tendency to inappropriately use new technology (eg, electron beam CT and multidetector CT). These new imaging procedures frequently help advance the science, but they also require grounding with expert readers and a conservative amount of electronic manipulation. Case reports such as the present that “conclude” that electron beam CT angiography correctly detects anomalous coronary origins and course should be taken with the following reservations: (1) these reports usually present cases already diagnosed by traditional angiography, and (2) the studies are frequently incomplete, nebulous, and (most concerning) potentially misleading, if not performed by those expert in both coronary anomalies and coronary imaging.