PMC7085419_01
Coronary angiography in right anterior oblique 30-degree projection showing intermediate lesions of the proximal left anterior descending artery and the ramus intermedius as well as a large "fistula" (arrow heads) taking off from the circumflex artery (panel A); CT of the chest indicating a smaller left hemithorax and the absence of the left pulmonary artery (panel B); CT angiography showing the right descending aorta and multiple collaterals (arrow heads) close to the ascending aorta (panel C); and three-dimensional reconstruction of the intrathoracic structures with large collateral vessels arising from both subclavian arteries (arrows, panel D). CT, computed tomography.
10-1055-s-0040-1702212-i1900346crc-1.jpg
PMC7085419_01_10-1055-s-0040-1702212-i1900346crc-1.jpg
FI1900346crc-1
A large coronary fistula ( Fig. 1 , panel A) arising from the circumflex artery (CX) had already been described, but at that time, no further action had been taken. His chest CT showed a smaller left and larger right hemithorax together with fibrotic and emphysematous changes of the left lung ( Fig. 1 , panel B). The underlying cause was an agenesis of the left pulmonary artery ( Fig. 1 , panel B). Collaterals from the heart (fistula coming from the CX), the left and right subclavian arteries, as well as the superior phrenic artery ( Fig. 1 , panels C and D) ensured left lung tissue supply.