Demonstration of coronary-to-pulmonary fistula with MDCT and conventional angiography

Yi̇ği̇ner, Ömer; Baş, Serap; Feray, Hasan

doi:10.1016/j.ijcard.2008.03.002

Cited by 11 publications

(23 citation statements)

References 6 publications

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“…There are several case reports of CPAF diagnosed by MDCT [1,[4][5][6]9]. According to previously reported cases, the variable morphologic features of fistulas were easily identified by using MDCT.…”

Section: Discussionmentioning

confidence: 98%

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Coronary to pulmonary artery fistula: morphologic features at multidetector CT

Kim

Jung

Chun

2010

Int J Cardiovasc Imaging

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The objective of this study is to evaluate the incidence and morphologic features of coronary-pulmonary artery fistulas (CPAF) by multidetector computed tomography (MDCT). From 2006 to 2008, 5,372 patients underwent ECG-gated cardiac CT scans using 64-slice MDCT at our institute. Among them, 17 cases of CPAF were detected (M:F = 14:3, mean age = 63 years). Chief complaints of patients were chest pain (n = 12), abnormal cardiac test (n = 3), known coronary artery disease (n = 1), and known CPAF (n = 1). We retrospectively analyzed the morphologic features of CPAF, such as origin vessels, draining site, fistula size, and aneurysmal sac. Five cases underwent coronary angiography (CAG) and correlated with MDCT findings. Incidence of CPAF was 0.32% by MDCT. The origin of CPAF was the left coronary artery in five (29.4%), the right coronary artery in two (11.8%) and both coronary arteries in ten cases (58.8%). In regard to the diameter of the detected fistula, the diameter of the largest vessel excluding aneurysm was variable from less than 2 to 5.7 mm. Five patients (29.4%) had a fistula that was shown as one vessel that could be traced, one patient (5.9%) was shown as two vessels, and eleven patients (64.7%) were shown as innumerable multiple vessel networks. Five cases were associated with aneurysm (29.4%). Fistulas were located primarily in the left anterolateral aspect of the pulmonary trunk (82.3%) and mostly the drainage site was the left lateral side of the pulmonary trunk (82.3%). CAG was performed in five cases and revealed identical findings to MDCT. In conclusion, coronary-pulmonary artery fistula is more frequently found than anticipated on MDCT. CPAF is supplied by either single or both coronary arteries and drains to the left side of the pulmonary trunk. It is typically located in the anterolateral aspect of the pulmonary trunk. Sometimes CPAF is associated with aneurysms.

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Section: Discussionmentioning

confidence: 98%

“…Studies on CPAF applied MDCT have been reported previously; nonetheless, most of them are studies limited to one or two cases or included in the description of diverse CAFs [1,[4][5][6], and sufficient and well-organized data on CPAF are not present.…”

Section: Introductionmentioning

confidence: 99%

Coronary to pulmonary artery fistula: morphologic features at multidetector CT

Kim

Jung

Chun

2010

Int J Cardiovasc Imaging

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“…because of the severely diluted contrast medium 12,14,15 ( Figures 2 and 4). Third, the invasive nature of conventional angiography has a mortality of 0.1%.…”

Section: Discussionmentioning

confidence: 99%

Coronary artery fistula in adults: evaluation with dual-source CT coronary angiography

Zhou

Kong²,

Y³

et al. 2015

BJR

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Conclusion: Coronary-pulmonary artery fistula in adults was found more often than in previous studies. CAF commonly originates from LCA or both LCA and RCA in adults. DSCT is a robust tool for investigating the origin, course and drainage site of CAF and coexistent abnormalities. Advances in knowledge: A large adult patient cohort who underwent DSCT angiography was reviewed to assess CAFs. Coronary-pulmonary artery fistula in adults was found more often than in previous studies. CAF was observed to originate from the LCA or both coronary arteries in adults. DSCT could clearly depict the fistula origin, course, drainage site and coexisting abnormalities. Conventional angiography results, treatments and followup DSCT images were analysed.Coronary artery fistulas (CAFs) are anomalous connections of the coronary arteries. The phenomenon was first described in 1865 by Krause. 1 CAF is considered as a major coronary anomaly by Ogden's classification.2 Most CAFs are congenital. CAFs have an estimated prevalence of 0.002% in the general population; however, they are present in 0.05-0.25% of patients who undergo coronary angiography.3-5 The traditional diagnosis tool for CAFs is conventional angiography. With the advent of 64-slice multidetector CT in chest and cardiac imaging, the number of incidentally found CAFs has been increasing. The advanced electrocardiogram (ECG)-gated technique of dual-source CT (DSCT) could provide high diagnostic accuracy for the assessment of coronary artery disease.According to prior studies, CAF arises from the right coronary artery (RCA) in approximately 50% of patients. [6][7][8] In particular, 70% of the CAFs in children (mean age, 2.9 years) originated from the RCA. 9 In this study, we focused on adult patients. A large cohort of adult patients who underwent DSCT angiography was reviewed to assess CAFs. The CAFs and coexisting abnormalities were analysed. METHODS AND MATERIALS PatientsA total of 17,548 patients who were suspected of having coronary artery disease underwent contrast-enhanced CT angiography (CCTA) from January 2008 to October 2013 in Peking Union Medical College Hospital, Beijing, China. The CCTA reports and images were retrospectively reviewed. Four experienced radiologists reviewed the axial, maximum intensity projection and volume rendering technique images of all 17,548 patients through the picture archiving and communication system. All the images were reviewed only once because of the large amount of work.

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“…Coronary arterial fistulae draining into the left ventricle (arterio-systemic) are relatively uncommon, with a reported incidence of 1.2% of all coronary artery fistulae [4,5]. Furthermore, the arteriosystemic fistulae involving the left coronary artery or at least two major coronary arteries (''multiple'' or ''bilateral''), or three (''generalized'') major coronary arteries are extremely rare [8][9][10][11][12][13][14]. The etiology of these fistulous communications has been attributed to a persistence of embryonic sinusoids that are usually obliterated in normal development [6,7].…”

Section: Discussionmentioning

confidence: 99%

“…Generalized coronary arteriosystemic fistulae are reported to be exceedingly rare [4,5]. In the past, the definite diagnoses of such patients have only been made by CAG; however, it has recently been reported that coronary artery fistulae can be detected by various kinds of non-invasive cardiac imaging modalities, such as transthoracic echocardiography (TTE), contrast echocardiography, and MDCT coronary angiography (coronary CTA) [9][10][11][12][13][14]. In this report, a case involving an elderly woman in whom generalized coronary arteriosystemic fistulae were incidentally identified during CAG, as well as non-invasively with contrast echocardiography and coronary CTA, is described.…”

Section: Introductionmentioning

confidence: 99%

Non-invasive recognition of generalized coronary arteriosystemic fistulae by contrast echocardiography and multidetector CT

Woo

Koh

et al. 2011

Int J Cardiovasc Imaging

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Coronary artery fistulae, including generalized coronary arteriosystemic fistulae, are usually identified incidentally during invasive coronary angiographies. Generalized or multiple coronary arteriosystemic fistulae arise from all three major coronary arteries draining into the left ventricular chamber. In a patient with generalized coronary arteriosystemic fistulae, myocardial ischemia and diastolic volume overload of the left ventricle can be caused by a left-to-left shunt; however, the clinical and hemodynamic consequences are incompletely understood. We report the case of generalized coronary arteriosystemic fistulae in a 73-year-old female who presented with mild exertional dyspnea as an anginal equivalent. This case report represents the complementary, non-invasive role of transthoracic contrast echocardiography and multidetector computed tomography (MDCT) coronary angiography in the early recognition of generalized coronary arteriosystemic fistulae by demonstrating a plexus of multiple small vessels emptying exclusively into the left ventricle.

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Demonstration of coronary-to-pulmonary fistula with MDCT and conventional angiography

Cited by 11 publications

References 6 publications

Coronary to pulmonary artery fistula: morphologic features at multidetector CT

Coronary to pulmonary artery fistula: morphologic features at multidetector CT

Coronary artery fistula in adults: evaluation with dual-source CT coronary angiography

Non-invasive recognition of generalized coronary arteriosystemic fistulae by contrast echocardiography and multidetector CT

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