Coronary artery to pulmonary artery fistula visualized with 3D cinematic rendering.
J Cardiovasc Comput Tomogr. 2017 Dec 2. pii: S1934-5925(17)30252-6. doi: 10.1016/j.jcct.2017.11.011. [Epub ahead of print] Rowe SP1, Fishman EK2.
A 70-year-old man with no cardiac or respiratory symptoms was referred for contrast-enhanced chest CT angiogram to evaluate a possible dilated aortic root noted on chest X-ray. While the ascending aorta was mildly dilated (measuring approximately 4.0 cm in diameter), an unsuspected and unrelated coronary artery to pulmonary artery fistula (CPAF) involving both the left anterior descending (LAD) and right coronary arteries was also noted. As is typical for this type of anomaly, this CPAF coursed along the anterior aspect of the main pulmonary artery and demonstrated aneurysmal dilation of the fistulous vessels,1 particularly those draining from the LAD (red arrowheads in Fig. 1). The asymptomatic patient in this case is currently being monitored with serial imaging and there are no plans to pursue any invasive procedures related to his CPAF.