PMC5122693_01
Left coronary artery fistula to the pulmonary artery.. (A) Invasive coronary angiogram of the Left coronary artery (X) in left anterior oblique projection. An abnormal vessel is seen taking a superior course (white arrows). Rapid contrast dilution (not seen) renders termination of the vessel difficult.. (B and C) CT reconstruction in a left anterior oblique orientation - same used for coronary angiogram - using maximal MIP (B) and VR (C). MIP shows a similar image to conventional angiograms. VR reconstruction allows better delineation of the relations, in this case showing an anterior position relative to the left coronary.. (D) tri-dimensional reconstruction of the whole coronary tree, with two fistulas seen (black star, from the right coronary, see Fig. 2).. (E) curved MPR, depicting the entire course of the fistula and the lumen diameter of the fistula.. (Ao: aorta; PA: pulmonary artery; RCA: right coronary artery; LCA: left coronary artery; MIP: maximum intensity projection; MPR: multiplanar reconstruction; VR: volume rendering)
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PMC5122693_01_gr1.jpg
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Due to clinical suspicion of coronary pathology, she was submitted to invasive coronary angiogram, which showed a fistula from the anterior descending artery to the pulmonary artery (Fig. 1A), with no other significant changes in the coronary arteries, having been discharged for outpatient investigation with the diagnosis of acute coronary syndrome of a non-atherosclerotic cause. A contrast enhanced coronary computed tomography was performed in a 64-slices device, with retrospective cardiac gating (Fig. 1).
Right coronary artery fistula to the right pulmonary artery.. (A) VR reconstruction, after removal of removal of much of the aorta and pulmonary artery, with a smaller fistula (star) coursing anterior to the aorta toward the pulmonary artery.. (B) tridimensional reconstruction of the whole coronary tree, with the right coronary fistula showed with a star.. (C) curved MPR, showing the entire course of the fistula and the diameter of the fistula.. (Ao: aorta; PA: pulmonary artery; RCA: right coronary artery; LCA: left coronary artery; MPR: multiplanar reconstruction; VR: volume rendering)
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A second fistula was depicted in the right coronary artery, with a caliber of about 0.9 mm, coursing towards the right branch of the pulmonary artery (Fig. 2).