Fixed Defect on Stress Myocardial Imaging Resulting From Previous Trauma Masquerading as Coronary Artery Disease

Myocardial perfusion imaging is a useful adjunct to exercise or pharmacologic stress testing in the detection of coronary artery disease. However, this modality is prone to false-positive results mostly related to patient body habitus. A 63-year-old woman was admitted with anginal chest pain. Cardiac enzymes were negative, and the patient underwent adenosine Tc-99m tetrofosmin stress testing. Perfusion imaging revealed a predominantly fixed defect involving the anterior and anterolateral walls of the left ventricle and an ejection fraction of 31%. Subsequently, the patient had a cardiac catheterization that showed normal coronary arteries and a focal aneurysm in the anterior wall.