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A case of coronary artery fistula draining into the pericardium causing hematoma
H Mutlu1, M Serdar Küçükoğlu, H Ozhan
1Istanbul University, Institute of Cardiology, Haseki 34304, Istanbul, Turkey. hasimmutlu@hotmail.com
Insights
A rare case of pericardial hematoma caused by a coronary artery fistula was successfully treated. This unique condition, presenting as chest pain and dyspnea, highlights the importance of comprehensive cardiac imaging and surgical intervention.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Coronary artery fistulas are abnormal connections between a coronary artery and a cardiac chamber or vessel.
- Pericardial hematomas are rare collections of blood within the pericardium.
Observation:
- A 28-year-old female presented with dyspnea and chest pain.
- Transesophageal echocardiography revealed a large left ventricular mass causing myocardial dysfunction.
- Coronary angiography identified a left anterior descending artery fistula draining into a pericardial cystic mass.
Findings:
- Initial suspicion of hydatid cyst was ruled out by negative serological tests for Echinococcus granulosus.
- Magnetic resonance imaging suggested a hematoma within the cystic mass.
- Surgical excision of the cystic lesion and ligation of the coronary artery fistula were performed without complications.
Implications:
- This case represents the first reported instance of a pericardial hematoma secondary to a coronary artery fistula in the English literature.
- Accurate diagnosis requires a combination of advanced imaging modalities.
- Surgical management is effective for this rare cardiovascular anomaly.
Abstract:
A 28-yr old female patient admitted to our clinic because of dyspnea and chest pain. Her transesophageal echocardiography demonstrated a huge mass on the anterolateral wall of the left ventricle causing dysfunction of the myocardium. Coronary angiography demonstrated left anterior descending artery fistula draining into the pericardial cystic mass. Hydatic cyst was suspected and ELISA and hemagglutinin tests were both negative for Echinococcus granulosus. Magnetic resonance image of the heart showed a mass thought to be a hematoma inside the cyst. She underwent surgery. The cystic lesion with a pure hematoma inside, was excised, and the fistula between left anterior descending artery and the mass was ligated without any complications. To our knowledge, this is the first case of a pericardial hematoma due to a coronary artery fistula, in the English literature.