Sudden death is the most abrupt clinical presentation of acute coronary syndrome. The presence of acute luminal thrombosis is the histopathological hallmark of sudden coronary death. There are 3 main etiologies that can give rise to an acute luminal thrombus: plaque rupture, plaque erosion and, less frequently, eruptive calcified nodules. Coronary computed tomography angiography (CCTA) has the ability to identify high-risk plaque features of coronary artery disease that are associated with future adverse cardiac events. In this report, we illustrate 2 cases of suspected sudden coronary death with a thorough description of how CCTA can be employed to detect high-risk plaque features using histopathology as a gold standard.