CTICasesRight Coronary Artery to SVC Fistula and Bronchial Artery to SVC Shunt
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Imaging findings
CT angiography reveals an unusually large right coronary artery originating from the cusp, with a tortuous branch extending posteriorly behind the aortic root, then superiorly to plug into the SVC. Additionally, large bronchial arteries are noted in the subcarinal space, with one branch originating from the aorta, passing under the pulmonary artery, and also plugging into the same SVC fistula. These findings represent two distinct left-to-right shunts.
Key takeaways
Coronary artery fistulas and bronchial artery shunts to the SVC are abnormal communications that can lead to left-to-right shunting and potential right heart overload. Bronchial cardiac anastomoses can persist embryologically and are often seen in the presence of other shunts. CT angiography is excellent for delineating these complex vascular anomalies.
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