Coronary to pulmonary artery fistula: morphologic features at multidetector CT

Abstract

The objective of this study is to evaluate the incidence and morphologic features of coronary-pulmonary artery fistulas (CPAF) by multidetector computed tomography (MDCT). From 2006 to 2008, 5,372 patients underwent ECG-gated cardiac CT scans using 64-slice MDCT at our institute. Among them, 17 cases of CPAF were detected (M:F = 14:3, mean age = 63 years). Chief complaints of patients were chest pain (n = 12), abnormal cardiac test (n = 3), known coronary artery disease (n = 1), and known CPAF (n = 1). We retrospectively analyzed the morphologic features of CPAF, such as origin vessels, draining site, fistula size, and aneurysmal sac. Five cases underwent coronary angiography (CAG) and correlated with MDCT findings. Incidence of CPAF was 0.32% by MDCT. The origin of CPAF was the left coronary artery in five (29.4%), the right coronary artery in two (11.8%) and both coronary arteries in ten cases (58.8%). In regard to the diameter of the detected fistula, the diameter of the largest vessel excluding aneurysm was variable from less than 2 to 5.7 mm. Five patients (29.4%) had a fistula that was shown as one vessel that could be traced, one patient (5.9%) was shown as two vessels, and eleven patients (64.7%) were shown as innumerable multiple vessel networks. Five cases were associated with aneurysm (29.4%). Fistulas were located primarily in the left anterolateral aspect of the pulmonary trunk (82.3%) and mostly the drainage site was the left lateral side of the pulmonary trunk (82.3%). CAG was performed in five cases and revealed identical findings to MDCT. In conclusion, coronary-pulmonary artery fistula is more frequently found than anticipated on MDCT. CPAF is supplied by either single or both coronary arteries and drains to the left side of the pulmonary trunk. It is typically located in the anterolateral aspect of the pulmonary trunk. Sometimes CPAF is associated with aneurysms.

Multi-Detector CT Coronary Angiographic Findings of Coronary-to-Pulmonary Artery Fistula

“…This discrepancy with cardiac catheterization could have resulted from the difference in the modality used. In our study, 67% of CPAFs originated from both the right and left coronary arteries, which is in accordance with previous studies using CT (53-59%) (16)(17)(18)(19). The remaining 33% of CPAFs in our study originated from a single coronary artery; 25% of CPAFs originated from the LCA and 8% of CPAFs originated from the RCA.…”

Role of 256-slice MDCT in the evaluation of coronary artery fistula: A case series with review of literature

“…CTCA not only can demonstrate the complex anatomy non-invasively, but also it is easy to do the follow-up studies. 10 …”

Coronary Artery Fistula and Its Imaging Modalities—A Review Article

“…Kim et al [13] reported a 0.32% prevalence of CPAF, based on their finding of 17 CPAF cases in 5372 patients. Yun et al [14] reported 29 CPAF cases in 6624 patients who underwent CTCA, resulting in an even higher prevalence of 0.44%.…”