title: Right coronary artery fistula to the coronary sinus and right atrium associated with giant right coronary enlargement detected by transthoracic echocardiography.
abstract: We present the case of a 54-year-old female with a previous history of lung fibrosis secondary to methotrexate used for rheumatoid arthritis who was referred to cardiology evaluation due to precordial pain. Echocardiography showed biatrial enlargement with an enlarged coronary sinus and tubular image posterior to the heart. On the coronary angiogram, the right coronary artery was enlarged, and a distal fistula was identified. The patient underwent a contrast enhanced cardiac computed tomography which demonstrated an aneurysmatic right coronary artery with a distal fistula to the right atrium and coronary sinus. As the chest pain did not recur and there was a high risk of the intervention to correct coronary fistula, the patient remained on conservative treatment.
authors.affiliation: Division of Internal Medicine, University Hospital, University of Sao Paulo Medical School, Sao Paulo, Brazil. msbittencourt@bol.com.br
authors.forename: Márcio Sommer
authors.initials: MS
authors.lastname: Bittencourt
authors.forename: Martin
authors.initials: M
authors.lastname: Seltman
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.forename: Christian
authors.initials: C
authors.lastname: Rost
authors.forename: Dieter
authors.initials: D
authors.lastname: Ropers
mesh_terms: D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D017023:Coronary Angiography / Q000379:methods; D054326:Coronary Sinus / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011658:Pulmonary Fibrosis / Q000175:diagnosis / Q000628:therapy; D018570:Risk Assessment; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods; D016157:Vascular Fistula / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy