CTICasesAnomalous Right Coronary Artery with Coronary Artery Fistula to Right Ventricle
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Imaging findings
Coronary CT angiography showed an enlarged left main coronary artery. The right coronary artery ostium was absent. Following the left main coronary artery and proximal left anterior descending artery, an anomalous artery branched off, taking a sharp right turn with a pre-pulmonic course, identified as the right coronary artery. This anomalous right coronary artery then looped around, displayed a small aneurysm, and demonstrated a distinct 'puff of contrast' emptying directly into the right ventricle.
Key takeaways
This case illustrates a complex combination of congenital coronary anomalies: an anomalous origin of the right coronary artery from the left main coronary artery with a pre-pulmonic course, coupled with a large coronary artery fistula draining into the right ventricle. The enlarged left main coronary artery and patient's symptoms are explained by the fistula, which creates a 'steal phenomenon' due to significant shunting. These congenital variants, even if present from birth, can manifest clinically with symptoms later in life.
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