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Right coronary artery aneurysm with fistula to left ventricle: multislice CT appearance

Nobusada Funabashi1, Miki Asano, Issei Komuro

  • 1Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Inohana, Chiba, Japan. nobusada@ma.kcom.ne.jp

Journal of Thoracic Imaging
|March 16, 2006
PubMed

Insights

A large right coronary artery aneurysm was identified in a 34-year-old male, directly connecting to the left ventricle. This finding suggests a rare coronary artery fistula requiring further investigation.

Area of Science:

  • Cardiovascular Imaging
  • Interventional Cardiology
  • Congenital Heart Disease

Background:

  • Coronary artery aneurysms are rare vascular abnormalities.
  • Coronary artery fistulas, abnormal connections between coronary arteries and heart chambers, are uncommon.
  • Diagnosis often relies on advanced imaging techniques.

Observation:

  • A 34-year-old male presented with cardiomegaly.
  • ECG-gated multislice CT revealed a diffuse, hugely enlarged right coronary artery (RCA) aneurysm.
  • The distal RCA appeared to directly drain into the left ventricle (LV).

Findings:

  • 3D reconstructions confirmed a massive aneurysm involving proximal, mid, and distal segments of the RCA.
  • The abrupt disappearance of the distal RCA aneurysm without distal branches strongly indicated a right coronary artery to left ventricle fistula.
  • The patient had prior radiographic evidence of cardiac enlargement.

Implications:

  • This case highlights the importance of advanced CT imaging in diagnosing complex coronary artery anomalies.
  • Accurate identification of coronary artery fistulas is crucial for appropriate management and preventing complications.
  • Further evaluation is warranted to determine the hemodynamic significance and guide therapeutic strategies.

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