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Image challenge
A 42-year-old woman with acute myocardial infarction
  1. James K Fahey1,2,
  2. Abdul Rahman Ihdayhid1,2,
  3. Anthony John White1,2
  1. 1 Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia
  2. 2 Monash Heart, Monash Health, Clayton, Victoria, Australia
  1. Correspondence to Dr Anthony John White, Monash Cardiovascular Research Centre and MonashHeart, Monash Health, Clayton, VIC 3168, Australia; Anthony.White{at}


Clinical introduction A 42-year-old woman presented with anterior ST elevation myocardial infarction. Urgent coronary angiography revealed tapering then occlusion of the distal left anterior descending (LAD) coronary artery with no flow in the distal LAD (figure 1A). Balloon angioplasty with a 2.0×8 mm balloon re-established flow into the distal LAD. An angiogram of the right external iliac artery was also performed (figure 1B).

Figure 1

Invasive angiography of the left coronary system (A) and the right external iliac artery (B). The coronary angiogram (A) shows tapering and then occlusion (arrow) of the distal left anterior descending coronary artery.

Question Which of the following explains the abnormal appearance of the external iliac artery (figure 1B)?

  1. Atherosclerosis.

  2. Concertina effect.

  3. Fibromuscular dysplasia.

  4. Perforation.

  5. Multiple aneurysms.

  • acute coronary syndromes

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  • Contributors AJW and ARI performed the clinical case, recognised the association of spontaneous coronary dissection with fibromuscular dysplasia of non-coronary artery and gathered the images. JKF, ARI and AJW drafted the manuscript and gave final approval of the version published. JKF, ARI and AJW agreed to be accountable for all aspects of the work.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.