Imaging of the coronary artery fistula from left main coronary artery to pulmonary artery with multidetector computed tomography

Coronary artery fistulas (CAFs) are mostly congenital, but they have been reported to be acquired as complications of chest trauma or medical procedures. Most adults with CAFs are diagnosed incidentally, because they are initially asymptomatic. CAFs are usually discovered on routine coronary angiography or at autopsy. In this article, we present a 54-year-old male with an asymptomatic left main coronary artery to main pulmonary artery fistula in which the diagnosis was made by multidetector computed tomography (MDCT) and coronary angiography. Reconstructed images obtained on MDCT coronary angiography are illustrated with correlative angiographic images. It shows MDCT could be useful in diagnosis and in delineating the complex anatomy of a coronary artery fistula as well as for conventional coronary angiography.