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Sinoatrial Nodal Artery Fistula to Left Atrium

Imaging findings

CT coronary angiography shows marked, tortuous dilation of the sinoatrial (SA) nodal branch arising from the right coronary artery, which is seen communicating directly with the left atrium, representing a coronary-cameral fistula.

Key takeaways

Coronary-cameral fistulas are vascular anomalies where coronary artery branches drain directly into a cardiac chamber. A fistula involving the SA nodal artery is rare, presenting as a tortuous, dilated atrial branch that can create a left-to-right shunt and trigger atrial arrhythmias.

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