An unusual case of coronary fistula diagnosed by multidetector computed tomography

Area of Science:

• Cardiology
• Radiology
• Anatomy

Background:

• Coronary artery fistulas are rare congenital or acquired abnormalities.
• Chest pain is a common symptom requiring investigation, including advanced imaging.

Observation:

• An 82-year-old hypertensive female presented with chest pain.
• Multidetector computed tomography angiography was performed for diagnostic evaluation.

Findings:

• A large coronary artery fistula was identified.
• The fistula originated from the anastomosis of the left anterior descending and posterior descending arteries near the left ventricular apex.
• The fistula drained into the right atrium and the proximal right coronary artery.

Implications:

• This case highlights the importance of multidetector computed tomography angiography in diagnosing complex coronary artery anomalies.
• Understanding the specific drainage pathways of coronary fistulas is crucial for management and surgical planning.
• Coronary fistulas, though rare, should be considered in the differential diagnosis of chest pain, particularly when associated with atypical anatomical findings.