Aortocaval fistula mimicking an acute coronary syndrome.
A 75-year-old man complained of episodes of chest pain and dyspnea. An acute coronary syndrome was suspected but coronary angiography showed only mild stenosis (less than 50% reduction of vessel diameter) of the left anterior descending artery. We performed an aortography that showed a large infrarenal aneurysm with direct communication from the aorta to the inferior vena cava, forming an aortocaval fistula (ACF). The patient was immediately brought to the operating room where he underwent a successful surgical repair. The interesting aspect of our case is the clinical presentation mimicking an acute coronary syndrome with shock and bradyarrhythmias. The prompt diagnosis of ACF is very difficult because this rare pathology may present with several signs and symptoms. Surgery, or endovascular treatment in selected cases, is the only chance of survival.
Department of Cardiology and Vascular Surgery, 'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Italy. carlovigna@libero.it
Carlo
C
Vigna
Tiberio
T
Santoro
Antonio
A
Facciorusso
Giovanni
G
Paroni
Raffaele
R
Fanelli
D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis*; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000209:etiology; D001011:Aorta / Q000473:pathology* / Q000601:surgery; D001027:Aortography; D001164:Arteriovenous Fistula / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008297:Male; D010690:Phlebography; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging* / Q000601:surgery