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A. Volume-rendering computed tomography showing dilated and tortuous left coronary artery (arrows); B, C. Short-axis computed tomography images showing coronary artery-left ventricular fistulae (arrowhead) with dilated left coronary arteries (arrows) and noncompaction-like myocardium (a maximal noncompaction-to-compaction ratio of 2.0; asterisks); D. Conventional coronary angiography showing multiple coronary microfistulae (arrows).
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Coronary computed tomography angiography was performed, and volume-rendering image demonstrated significantly dilated and tortuous coronary arteries without stenosis (Fig. 1A). Intramyocardial enlarged vessels and transmural linear enhancement suggested coronary fistulae in the left ventricle (LV) (Fig. 1B, C), which was confirmed by conventional angiography (Fig. 1D). Coronary computed tomography angiography also showed endocardial-side "spongy myocardium" mimicking noncompaction with a maximal noncompaction-tocompaction ratio of 2.0 (Fig. 1C, asterisks).