Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Mar 9;2023(3):rjad108.
doi: 10.1093/jscr/rjad108. eCollection 2023 Mar.

Giant circumflex artery with bilobed saccular aneurysm and right atrial fistula mimicking a bi-atrial hydatid cyst: a case report

Aida Soufiani  1 , Hamza Chraibi  1 , Samah El-Mhadi  1 , Zineb Agoumy  1 , Zineb Fassi Fehri  1 , Rokya Fellat  1 , Adil Bensouda  2 , Nesma Bendagha  1 , Said Moughil  2
Affiliations
Case Reports

Giant circumflex artery with bilobed saccular aneurysm and right atrial fistula mimicking a bi-atrial hydatid cyst: a case report

Aida Soufiani et al. J Surg Case Rep. .

Abstract

Coronary artery fistulas (CAF) are rare anomalies that pose a significant diagnostic and therapeutic challenge. Most of them originate from the right coronary artery and are congenital. They are often associated with coronary aneurysms. We report the case of a 38-year-old Black man who presented with exertion dyspnea. Transthoracic echocardiography found what was thought to be a bi-atrial hydatid cyst, alongside a right atrial shunt. Cardiac magnetic resonance imaging showed a cystic lesion hypointense on T1 and T2 sequences, located next to the left atrium as well as an aneurysmal circumflex artery shunting in the right atrium. Coronary angiography and computed tomography angiography confirmed the bilobed circumflex saccular aneurysm and CAF. The patient underwent a successful surgery, which consisted of closure of the fistula using two patches. He was discharged after an uneventful postoperative course. Our case report illustrates the diagnostic difficulty of CAF and the importance of multimodal imaging.

Keywords: Coronary aneurysm; Coronary artery fistula; Coronary cameral fistula; Multimodal imaging.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Initial TTE. (A) Parasternal short-axis view showing a bi-atrial cystic lesion; (B) apical 4-chamber view showing color Doppler aliasing in the RA, indicating a shunt. RV, right ventricle; LV, left ventricle; C, cystic lesion.
Figure 2
Figure 2
CMR. (A) T1 sequence showing a cystic hypointense lesion, with the same signal than cardiac chambers, located below and behind the LA; (B) T2 sequence showing the hypointense lesion; (C) vertical long axis view showing the bilobed lesion; (D) cine imaging showing an aneurysmal circumflex artery with a right atrial shunt. RV, right ventricle; LV, left ventricle; C, cystic lesion.
Figure 3
Figure 3
CA showing a giant aneurysmal circumflex artery.
Figure 4
Figure 4
CCTA (with 3D reconstruction) showing the CAF alongside a bilobed saccular aneurysm fed by a giant circumflex artery, next to the RA. A, aneurysm of the circumflex artery; LCX, circumflex artery.
Figure 5
Figure 5
Picture of the surgery showing the patching of the CAF.
Figure 6
Figure 6
Postoperative TTE showing the disappearance of the right atrial shunt. RV, right ventricle; LV, left ventricle.
See this image and copyright information in PMC

References

    1. Loukas M, Germain AS, Gabriel A, John A, Tubbs RS, Spicer D. Coronary artery fistula: a review. Cardiovasc Pathol 2015;24:141–8. - PubMed
    1. Luo L, Kebede S, Wu S, Stouffer GA. Coronary artery fistulae. Am J Med Sci 2006;332:79–84. - PubMed
    1. Yuksel S, Yasar E, Nar G, Gulel O, Demircan S, Yilmaz O, et al. . Prevalence and characteristics of coronary-cameral communications in adult patients: coronary angiographic analysis of 16,573 patients. Med Princ Pract 2014;23:336–9. - PMC - PubMed
    1. Chiu CZ, Shyu KG, Cheng JJ, Lin SC, Lee SH, Hung HF, et al. . Angiographic and clinical manifestations of coronary fistulas in Chinese people: 15-year experience. Circ J 2008;72:1242–8. - PubMed
    1. Said SA. Current characteristics of congenital coronary artery fistulas in adults: a decade of global experience. World J Cardiol 2011;3:267–77. - PMC - PubMed

Publication types