CTICasesRCA Sinoatrial Nodal Branch Fistula Draining to Right Atrium
Imaging findings
Cardiac MRI shows a mass-like artifact in the right atrium with abnormal, two-directional flow on phase contrast imaging. Further investigation reveals a large, very abnormal proximal right coronary artery (RCA) with a huge vessel branching off, winding around, and draining into the right atrium. This large RCA sinoatrial nodal branch fistula causes the mass-like artifact and right heart enlargement, including an enlarged right atrium. Pulmonary veins drain normally.
Key takeaways
Large coronary artery fistulas, such as a sinoatrial nodal branch fistula from the RCA to the right atrium, can cause significant flow-related artifacts on cardiac MRI that may be mistaken for a mass. These fistulas can lead to right heart enlargement and present with symptoms like shortness of breath. Anomalous pulmonary vein may be an initial misdiagnosis on echo due to abnormal flow near the SVC/RA junction.
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