Korean Circ J.  2012 Mar;42(3):205-207. 10.4070/kcj.2012.42.3.205.

Contrast Echo-A Simple Diagnostic Tool for a Coronary Artery Fistula

• Hong SM
• Yoon SJ
• Rim SJ

• KMID: 2225036
• DOI: http://doi.org/10.4070/kcj.2012.42.3.205

Abstract

Coronary artery fistulas have been diagnosed with aortography, coronary angiography, and coronary computed tomography (CT). A large fistula can be occasionally found as a mass lesion on echocardiography but cannot be easily confirmed. Here, we report a new diagnostic approach to coronary artery fistulas using a contrast agent and transthoracic echocardiography. Transthoracic echocardiography of a 46-year-old female suffering from dyspnea revealed suspicious small turbulent flow in the main pulmonary artery. Following infusion of a contrast agent, we found whitish flow in the main pulmonary artery during the diastolic phase, and aortic CT revealed two huge right coronary artery fistulas in the main pulmonary artery. A simple diagnostic approach to a coronary artery fistula using contrast agent helped us confirm the diagnosis because of the typical diastolic whitish flow in the pulmonary artery.

Keyword

Coronary artery fistula; Echocardiography; Contrast agent

MeSH Terms

Aortography
Coronary Angiography
Coronary Vessels
Dyspnea
Echocardiography
Female
Fistula
Humans
Middle Aged
Pulmonary Artery
Stress, Psychological

Figure

• 

  Fig. 1 Echocardiographic findings of a coronary fistula with Doppler and contrast agent. Parasternal short axis view showing abnormal, small turbulent flow in the main pulmonary artery (A), and Doppler revealed diastolic-dominant flow (B, white arrow heads). Systolic and diastolic flow in the pulmonary artery were shown with contrast infusion (C and D), and an unusual whitish flow was noted in the main pulmonary artery during the diastolic phase (D, white arrow heads).

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  Fig. 2 Computed tomographic findings of the coronary fistula. Aortic computed tomography revealed two huge right coronary artery fistulas in the main pulmonary artery (white arrows).

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