title: Double congenital fistulae with aneurysm diagnosed by combining imaging modalities.
abstract: Congenital coronary pulmonary artery fistula (CAF) is rare, and systemic-to-pulmonary artery fistula (SPAF) is even more so. Furthermore, congenital coronary pulmonary fistula associated with congenital SPAF is extremely rare. As far as we know, CAF and SPAF connected with an aneurysm have not been described very often. We described an 83-year-old woman with an aneurysm originating from a CAF connected to an aortopulmonary artery fistula. Chest radiography revealed a shadow at the left edge of the heart line. Multi-detector-row computed tomography (MDCT) with contrast enhancement and coronary cine angiography revealed that the shadow was an aneurysm connected to a tortuous fistula at the left anterior descending coronary artery. The aneurysm was formed by congenital coronary pulmonary and aortopulmonary artery fistulae. Echocardiography revealed predominantly systolic blood flow in the fistula from the left anterior descending coronary artery (LAD). Although neither MDCT, echocardiography nor coronary angiography alone could provide a comprehensive image of the anomaly, including the hemodynamics in the fistulae and their relationship with surrounding organs and tissues, their combination could provided important facts the led to a deeper understanding of this very uncommon occurrence.
authors.affiliation: Department of Cardiology and, Himeji Red Cross Hospital, Himeji, Hyogo 670-8540, Japan.motomitachibana@yahoo.co.jp.
authors.forename: Motomi
authors.initials: M
authors.lastname: Tachibana
authors.forename: Naoki
authors.initials: N
authors.lastname: Mukouhara
authors.forename: Ryouichi
authors.initials: R
authors.lastname: Hirami
authors.forename: Hideki
authors.initials: H
authors.lastname: Fujio
authors.forename: Akihisa
authors.initials: A
authors.lastname: Yumoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Watanuki
authors.forename: Aiko
authors.initials: A
authors.lastname: Hayashi
authors.forename: Isao
authors.initials: I
authors.lastname: Suminoe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Koudani
mesh_terms: D000369:Aged, 80 and over; D001159:Arterio-Arterial Fistula / Q000150:complications / Q000000981:diagnostic imaging*; D003323:Coronary Aneurysm / Q000150:complications / Q000000981:diagnostic imaging*; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003952:Diagnostic Imaging / Q000379:methods*; D004452:Echocardiography; D005260:Female; D006801:Humans; D064847:Multimodal Imaging; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed