Aneurysm of coronary arteriovenous fistula presenting as a calcified mediastinal mass

Okita, Yutaka; Miki, Shigehito; Kusuhara, K; Ueda, Yuichi; Tahata, T; Sakai, Tetsuro; Tatsumi, Akitoshi; Kitano, Morihisa

doi:10.1016/0003-4975(92)91028-8

Cited by 17 publications

(10 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[2][3][4] We report an adult case of a huge aneurysm that was fed by both the left anterior descending and the right coronary artery draining anomalously into the main pulmonary artery. …”

mentioning

confidence: 99%

Huge Saccular Aneurysm in a Coronary-Pulmonary Fistula Fed by the Left and Right Coronary Arteries.

Hirooka

Hanatani²,

Nakatani³

et al. 2002

Circ J

View full text Add to dashboard Cite

ecause a communication between the coronary arteries and the cardiac chamber or the pulmonary trunk is not a common anomaly, 1 the formation of an aneurysm in this communication vessel is clinically few. [2][3][4] We report an adult case of a huge aneurysm that was fed by both the left anterior descending and the right coronary artery draining anomalously into the main pulmonary artery. Case ReportA 62-year-old woman was referred to hospital because of an abnormal mediastinal shadow on chest roentgenogram. She had been pointed out a heart murmur 30 years ago, but did not have further examinations because she did not have any symptoms. An abnormal shadow on the left cardiac border was first noted on plain chest roentgenogram 4 years ago and since then the size of the mass had gradually increased (Fig 1). However, she did not develop angina-like chest pain on effort.Physical examination revealed a grade 4/6 continuous cardiac murmur at the second intercostal space. Blood pressure was 135/80 mmHg. There was complete right bundle branch block on ECG. Two-dimensional echocardiography revealed a round cystic lesion with internal spontaneous echo contrast, located in contact with the pulmonary trunk (Fig 2). Computed tomography showed a giant mass of 5.8×6.0 cm in diameter into which the left and right coronary arteries drained (Fig 3). During catheterization, oximetry revealed an oxygen step-up of 4% between the pulmonary artery and the right ventricle, consistent with a left-to-right shunt of 3.4%. The pulmonic-to-systemic blood flow ratio (Qp/Qs) was 1.04. Digital subtraction coronary Circulation Journal Vol.66, May 2002 angiography confirmed that each branch of the left anterior descending artery and the right coronary artery drained into the huge aneurysm (Fig 4). However, the efferent vessels into the pulmonary artery were not clearly demonstrated by angiography, but color Doppler flow imaging revealed the small efferent flow was running from the aneurysm to the main pulmonary artery (Fig 5). From these findings, she was diagnosed as having a coronary -pulmonary fistula with a concomitant huge saccular aneurysm that was considered to have progressively enlarged during the preceding 4 years, and surgical resection was proposed.At operation, an egg-shaped, elastic, cardiac tumor 6 cm in diameter was found in front of the right ventricular outflow tract. The afferent vessels were confirmed to arise

show abstract

“…[2][3][4] We report an adult case of a huge aneurysm that was fed by both the left anterior descending and the right coronary artery draining anomalously into the main pulmonary artery. …”

mentioning

confidence: 99%

Huge Saccular Aneurysm in a Coronary-Pulmonary Fistula Fed by the Left and Right Coronary Arteries.

Hirooka

Hanatani²,

Nakatani³

et al. 2002

Circ J

View full text Add to dashboard Cite

show abstract

“…2) Some cases have reported that an aneurysm had progressively enlarged during their follow-up period. 9,10) In this case, chest X rays suggest that the saccular aneurysm has significantly enlarged for only 3 years. There are no defined risk factors in predicting the rupture of an aneurysm of a coronary arteriovenous fistula.…”

Section: Discussionmentioning

confidence: 76%

Rupture of a Giant Saccular Aneurysm of Coronary Arteriovenous Fistulas.

Ito

Kodama

Saeki³

et al. 2000

Jpn Heart J

View full text Add to dashboard Cite

SUMMARYA 58-year-old Japanese woman was admitted to our hospital because of chest pain. A continuous murmur was detected at the left parasternal area. Electrocardiogram showed ST elevation in leads V 2 , V 3 and V 4 . Chest computed tomography and echocardiography demonstrated pericardial effusion and a large mass which was adjacent to the pulmonary artery. An abnormal blood flow was detected in the mass by Doppler echocardiography. Coronary angiography confirmed that the mass was a giant aneurysm of coronary arteriovenous fistula arising from both the left and right coronary arteries. This patient had no symptoms until rupture of the fistula. Rupture of a coronary arteriovenous fistula is very rare but can be a cause of chest pain and pericardial effusion. 1) Therapeutic strategies for coronary arteriovenous fistulas have not been clearly defined because the natural histories of the disorder are still uncertain.2) The majority of coronary arteriovenous fistulas are small and asymptomatic, especially in young patients. In older patients, both symptoms and fistula-related complications increase.3) Surgical repair for coronary arteriovenous fistulas is generally recommended in the presence of symptoms of heart failure or large left-to-right shunts. 4)On the other hand, the management for asymptomatic patients with a coronary arteriovenous fistula is controversial. We report the rupture of a giant aneurysm of a coronary arteriovenous fistula presented by chest pain with pericardial effusion. The patient had no fistula-related symptoms until the rupture.

show abstract

“…4,5) Initially, the unusual presentation of the CAA involving the interatrial septum which seemed like "a cystic mass" or "the fifth chamber" resulted in a misdiagnosis. A saline contrast study was performed because the cystic lesion was suspected to be an anomalous opening of the vena cava.…”

Section: Discussionmentioning

confidence: 99%

A Coronary Artery Fistula With Saccular Aneurysm Mimicking a Right Atrial Cystic Mass

et al. 2004

View full text Add to dashboard Cite

SUMMARYA 16 year-old Korean girl with cardiomegaly was found to have a "right atrial cystic mass" on transthoracic echocardiography. An unusual cystic structure made the diagnosis difficult. However, transesophageal echocardiography and multidetector computed tomography revealed a coronary artery fistula with a distal saccular aneurysm involving the interatrial septum and draining into the right atrium. Multidetector computed tomography provided clear anatomic visualization that fully delineated the abnormal structures. Multidetector computed tomography may be considered as a good alternative for transesophageal echocardiography in assessing a tortuous coronary artery fistula and aneurysm with complex anatomy. (Jpn Heart J 2004; 45: 697-702)

show abstract

Aneurysm of coronary arteriovenous fistula presenting as a calcified mediastinal mass

Cited by 17 publications

References 9 publications

Huge Saccular Aneurysm in a Coronary-Pulmonary Fistula Fed by the Left and Right Coronary Arteries.

Huge Saccular Aneurysm in a Coronary-Pulmonary Fistula Fed by the Left and Right Coronary Arteries.

Rupture of a Giant Saccular Aneurysm of Coronary Arteriovenous Fistulas.

A Coronary Artery Fistula With Saccular Aneurysm Mimicking a Right Atrial Cystic Mass

Contact Info

Product

Resources

About