[A case of bilateral coronary-pulmonary artery fistula with multicystic saccular aneurysms]
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1Department of Pulmonary Medicine, Jichi Medical School, Tochigi, Japan.
Insights
This study reports a rare case of coronary artery fistula with multicystic aneurysms in an elderly woman. Immediate surgery was deemed unnecessary due to stable mass size over two years.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Coronary artery fistulas are rare congenital or acquired abnormalities.
- Multicystic saccular aneurysms associated with these fistulas are exceptionally uncommon, particularly in elderly individuals.
Observation:
- A 71-year-old woman presented with a chest X-ray abnormality.
- Imaging revealed a vascular mass with calcification, identified as a coronary artery fistula with multicystic aneurysmal dilatation originating from the left descending and right coronary arteries.
- The mass remained stable in size (3 cm) over a two-year follow-up period.
Findings:
- Coronary angiography confirmed a complex coronary artery fistula with multiple saccular aneurysms.
- Electrocardiography and exercise testing showed no significant abnormalities.
- The patient's condition was clinically stable, with no immediate indication for surgical intervention.
Implications:
- This case highlights the importance of advanced imaging in diagnosing rare vascular anomalies.
- Conservative management may be appropriate for stable, asymptomatic coronary artery fistulas with aneurysms.
- Further research into the natural history and optimal management of such rare conditions is warranted.
Abstract:
A 71-year-old woman was admitted to our hospital for evaluation of a chest X-ray abnormality. Heart murmur was not heard. Chest X-ray showed a bulge with calcification at left third arch. Chest computed tomography revealed contrast enhancement of masses, which appeared to originate from the vascular system. Coronary angiography demonstrated multicystic aneurysmal dilatation of a coronary artery fistula originating from the proximal left descending and right coronary artery. Electrocardiography showed no remarkable findings and a treadmill exercise test showed no significant ST-T change. The size of the mass of 3 cm in diameter on chest X-ray remained the same for two years. We concluded that surgery was not necessary immediately. In Japan, nineteen cases of coronary-pulmonary artery fistula with multicystic saccular aneurysms have been reported in the literature, including our case. The majority of these cases are elderly women from fifty to sixty years old.