CTICasesLarge Circumflex Coronary Artery Fistula to Coronary Sinus
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Imaging findings
A chest radiograph showed a large, somewhat globular cardiac silhouette, which had been present for several years. A CT scan, starting from the inferior cardiac structures, revealed massive dilation of the coronary sinus. Tracing superiorly, the left main coronary artery was enlarged, and a massively dilated circumflex artery was identified, connecting directly to the coronary sinus. Another tortuous vessel near or arising from the right coronary artery also appeared fistulous and connected to the coronary sinus. A follow-up exam after treatment showed a decrease in the left-sided fistula (after ligation of the left main coronary artery and LAD bypass), but the right-sided vessel persisted.
Key takeaways
This was described as the largest circumflex coronary artery fistula to the coronary sinus the presenters had seen. The patient presented with chest pain and severe steal symptoms. The treatment involved coronary bypass grafting and ligation of the left main coronary artery, resulting in significant symptom improvement. The case highlights the importance of considering fistulas in the presence of large coronary arteries and differentiates it from anomalous coronary origins.
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