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Case Reports
. 2015 Jan 30;12(1):e6878.
doi: 10.5812/iranjradiol.6878. eCollection 2015 Jan.

Multimodality imaging of left circumflex artery to coronary sinus fistula

Tan Ling Sze  1 , Yang Faridah Abdul Aziz  1 , Norzailin Abu Bakar  2 , Fadhli Mohd Sani  1 , Hamid Oemar  3
Affiliations
Case Reports

Multimodality imaging of left circumflex artery to coronary sinus fistula

Tan Ling Sze et al. Iran J Radiol. .

Abstract

Coronary artery fistula (CAF) is a rare anomaly of the coronary artery. Patients with this condition are usually asymptomatic. However, cardiac failure may occur later in life due to progressive enlargement of the fistula. Diagnosis is traditionally made by echocardiogram and conventional angiogram. However with the advantage of new technologies such as computed tomography (CT) coronary angiography, the course and communications of these fistulae can be delineated non-invasively and with greater accuracy. We report a case of a left circumflex artery fistula to the coronary sinus which was suspected on echocardiogram and the diagnosis was clinched on ECG-gated CT.

Keywords: Circumflex Artery; Computed tomography; Coronary Sinus; Fistula.

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Figures

Figure 1.
Figure 1.. A 35-year-old woman with recurrent attacks of palpitation since childhood. A) Transthoracic color Doppler echocardiography shows the dilated left circumflex artery (arrow) emptying into the big coronary sinus. B) Continuous turbulence flow on color Doppler at the level of coronary artery-coronary sinus connection as well as in the coronary sinus indicating a left-to-right shunts flow.
Figure 2.
Figure 2.. Axial (top left) and reconstructed images (top right and bottom) of coronary CT shows the dilated left circumflex artery (arrow) arising from the left coronary cusp and drains into the right atrium (*). AO = Aorta, CS = Coronary sinus, LA = Left atrium, LCX = Left circumflex artery, LV = Left ventricle, LVOT = Left ventricular outflow tract, PA = Pulmonary artery, RA = Right atrium
Figure 3.
Figure 3.. Volume rendering images of coronary CT show dilated left circumflex artery (Cx) (arrow).
Figure 4.
Figure 4.. Coronary angiography (anteroposterior view) demonstrates contrast opacified left circumflex artery that is markedly dilated. CS = Coronary sinus, LCX = Left circumflex artery, LM = Left main coronary artery
See this image and copyright information in PMC

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