Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and sudden cardiac death with high predilection for premenopausal women. The overall incidence of SCAD in patients referred for coronary angiography has been reported to vary between 0.1% and 1%. In a series of 94 antemortem and postmortem cases the mean age for men was 46 years and the mean age for women was 39 years. In this series, the dissection of right coronary artery was more common in men while the left coronary artery system was most commonly affected in women. Although the precise etiology of SCAD remains unclear, several risk factors such as atherosclerosis, connective tissue disorder, peri-partum episode, and trauma have been postulated. Consequently, SCAD could result in a wide spectrum of presentations ranging from chest pain to extensive myocardial infarction. Notably, sudden cardiac death has been a common mode of clinical presentation in many previously reported cases. While the definitive diagnosis of SCAD relies on invasive angiography, patients may be initially evaluated by noninvasive cardiac imaging tests. It is, therefore, important for imaging physicians to be aware of the potential imaging findings that can result from SCAD and to consider this diagnosis in the differential diagnosis in younger patients, particularly female, who present with acute chest pain. Figures 1, 2, 3, and 4 demonstrate four cases in which various non-invasive imaging modalities identified abnormalities that ultimately led to the diagnosis of SCAD.