Unmasking 5-fluorouracil cardiotoxicity: The clinical utility of dynamic myocardial CT perfusion: A case report

We report the first documented case in Peru of 5-fluorouracil (5-FU)-induced cardiotoxicity assessed using combined coronary computed tomography angiography (CCTA) and dynamic myocardial computed tomography perfusion (CTP). A 57-year-old male with metastatic pancreatic cancer undergoing FOLFOX chemotherapy developed chest pain during the second cycle. Coronary computed tomography angiography (CCTA) revealed non-obstructive calcified plaques, ruling out significant coronary artery disease. Due to a history of active asthma, adenosine stress was contraindicated; therefore, a hyperventilation-apnea maneuver was employed as an alternative pharmacologic stress method. Dynamic CTP imaging demonstrated global myocardial hypoperfusion under stress conditions without infarction, consistent with coronary vasospasm induced by 5-FU. This case highlights the diagnostic value of combining anatomical and functional CT imaging modalities for noninvasive evaluation of cardiotoxicity in oncology patients. Additionally, the hyperventilation-apnea maneuver proved to be a feasible and safe stress alternative in patients contraindicated for pharmacologic agents. Further studies are warranted to establish the role of dynamic CTP in the early detection and management of fluoropyrimidine-induced cardiotoxicity.