Spontaneous coronary artery dissection (SCAD) is thought to be a rare condition that is hard to predict due to the lack of easily identifiable warning signs. We report the case of a 49-year-old woman with a locally advanced Stage IIIB anal squamous cell carcinoma who presented with chest pain and a positive stress test, ST elevations in her inferior echocardiogram leads, and induced chest pain with exercise without heart perfusion defects. Coronary catheterization revealed a right coronary artery dissection, which led to the diagnosis of SCAD. Our patient was diagnosed while undergoing a combination treatment of fluorouracil (5-FU), mitomycin, and pelvic radiotherapy. We reviewed the current literature and update the etiologies that have been proposed since the publication of this case report.

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Routine transthoracic echocardiography (TTE) provides detailed information about intracardiac heart function and physiology. Although statements about the pericardium and visualization of extracardiac areas such as the liver and pleural space are provided in a report, it is often beyond the standard of practice for the cardiac sonographer and interpreting cardiologist to comment on extraneous thoracic abnormalities. This case study demonstrates the findings of a mediastinal thymoma detected by TTE and cross-correlation with thoracic computed tomographic angiography to further detail the existence and location of this incidental finding. The aim of this case study is to alert sonographers and physicians to this particular pathologic entity that was seen during an echocardiogram and can be further investigated for diagnostic completeness.