Myocardial ischemia at rest
84 year old male with history of pacemaker for sick sinus syndrome presents after syncope. Pacemaker interrogation shows ventricular tachycardia. A CT scan performed to evaluate for dissection shows a 4.9 cm abdominal aortic aneurysm.
Closer look at spectral images shows hypo-perfusion in the left ventricular septum and apex. Subsequent coronary angiography showed severe 3-vessel disease with critical stenosis in the mid-LAD.
This patient would have received a cardiac workup regardless of spectral CT findings; nevertheless, this case illustrates how spectral CT can make obvious subtle findings that can be life-threatening.