{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T10:34:48Z","timestamp":1787567688943,"version":"build-2736575974"},"reference-count":25,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>A 66-year-old man with hypertension, type 2 diabetes mellitus, and a 50-year smoking history was presented with acute chest pain clinically consistent with unstable angina. Coronary computed tomography angiography (CCTA) showed multivessel atherosclerosis and, more strikingly, diffuse sheath-like pericoronary soft-tissue cuffing around the major epicardial arteries\u2014an appearance reported as the \u201cmistletoe sign\u201d and compatible with immunoglobulin G4 (IgG4)-related coronary periarteritis. CT-derived fractional flow reserve (CT-FFR) measured 0.75 in the left anterior descending artery, 0.68 in the left circumflex artery, and 0.94 in the right coronary artery. Invasive angiography identified a 90% proximal left circumflex stenosis as the flow-limiting lesion; drug-eluting stent implantation restored Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow. Serum IgG4 (145 mg\/dL) was only marginally above the diagnostic threshold, and troponin was unavailable, so the diagnosis remained clinical. Without histopathology, the findings support possible rather than definite IgG4-related disease, and the contribution of the pericoronary process to the stenosis could not be established. The patient remained stable on conventional medical therapy. CCTA, CT-FFR, and angiography answer complementary questions; diffuse pericoronary change warrants serologic and systemic evaluation for inflammatory coronary involvement, with cautious etiologic attribution.<\/jats:p>","DOI":"10.3390\/diagnostics16172683","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T09:20:02Z","timestamp":1787563202000},"page":"2683","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diffuse Pericoronary Soft-Tissue Cuffing on Coronary Computed Tomography Angiography in a Patient with Unstable Angina: Possible IgG4-Related Coronary Periarteritis"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0902-6736","authenticated-orcid":false,"given":"Shuo","family":"Liang","sequence":"first","affiliation":[{"name":"Department of Radiology, Chest Hospital, Tianjin University, Tianjin 300222, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8399-3184","authenticated-orcid":false,"given":"Dan","family":"Li","sequence":"additional","affiliation":[{"name":"Clinical School of Thoracic, Tianjin Medical University, Tianjin 300070, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7670-626X","authenticated-orcid":false,"given":"Hong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Chest Hospital, Tianjin University, Tianjin 300222, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1186\/s13023-024-03266-y","article-title":"Coronary periarteritis and pericarditis are rare but distinct manifestations of heart involvement in IgG4-related disease: A retrospective cohort study","volume":"19","author":"Hua","year":"2024","journal-title":"Orphanet J. 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