Intravascular Ultrasound-Detected Layered Plaque Mimicking Spontaneous Coronary Artery Dissection

Diagnosing ambiguous culprit lesions by coronary angiography is challenging, particularly in the presence of vessel overlap, tortuosity, or eccentric lesions. In such cases, intravascular imaging provides critical diagnostic insights. We present the case of a 55-year-old female with recurrent chest pain, initially suspected to have spontaneous coronary artery dissection (SCAD) based on clinical context. Coronary angiography was inconclusive; however, intravascular ultrasound (IVUS) revealed distinct plaque layers with varying echogenicity separated by clear borders—findings more consistent with a layered plaque than SCAD. This case highlights the value of intravascular imaging in accurately characterizing ambiguous coronary lesions and guiding appropriate management.