False positive stress thallium and normal coronaries

This 45-years old lady had atypical chest pain and was referred for a stress thallium study, which shows an apical defect. Since there were no other findings suggestive of coronary artery disease, a cardiac CT was performed.

The CT shows evidence of pericardial effusion (Figs. 1, 2) and normal coronary arteries (Figs. 3,4). The function was also normal. Whether the pericardial effusion was the cause of the pain and/or also the reason for the findings on the stress thallium is still uncertain. However, with a normal coronary tree, it is almost definite there is no coronary artery disease.