PMC6183205_01
Chest radiograph (posteroanterior projection).
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fig1
Clinical examination, electrocardiogram, echocardiography and chest radiograph (Figure 1) were normal and he was referred for a cardiac CT scan to assess coronary artery calcification and patency (Figure 2a-c).
(a) Volume-rendered cardiac CT image demonstrates the fistulous communication (white and blue block arrows) between the right internal mammary artery (white chevron) and mid-right coronary artery (thin white arrow), and left internal mammary artery (thin blue chevron) and mid left anterior descending artery (thin blue arrow). (b, c) CT axial curved maximum intensity projections demonstrating the fistulous communication (white and blue block arrows) between the right internal mammary artery (white chevron) and mid-right coronary artery (thin white arrow), and left internal mammary artery (thin blue chevron) and mid left anterior descending artery (thin blue arrow).
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fig2
Clinical examination, electrocardiogram, echocardiography and chest radiograph (Figure 1) were normal and he was referred for a cardiac CT scan to assess coronary artery calcification and patency (Figure 2a-c). CT scan with volume-rendered and axial curved maximum intensity projection techniques elegantly demonstrated the fistulous communication (white and blue block arrows) between the right internal mammary artery (white chevron) and mid-right coronary artery (thin white arrow) and left internal mammary artery (thin blue chevron) and mid left anterior descending artery (thin blue arrow) (Figure 2).
(a) Coronary angiogram image demonstrating the fistulous communication (blue block arrow) between the left internal mammary artery (blue chevron) and mid-left anterior descending artery (thin blue arrow). (b) Coronary angiogram image demonstrating the fistulous communication (white block arrow) between the right internal mammary artery (white chevron) and mid-right coronary artery (thin white arrow).
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fig3
Coronary angiography confirmed patent coronary arteries and the presence of the fistulae (Figure 3a,b and Supplementary Videos B and C).