Multidetector-row Computed Tomography in Diagnosis of a Large Right Coronary Artery Aneurysm Resulting from Arteriovenous Fistula Kun-Eng Lim, 1 Kuei-Ton Tsai 2 and Yu-Lin Ko 3 Coronary artery aneurysm with arteriovenous fistula is an uncommon condition. We report a 52-year-old male with a large right coronary artery aneurysm resulting from a coronary artery-to-right ventricle fistula. The aneurysm and the fistula were demonstrated by an electrocardiography-gated multidetector-row computed tomography coronary angiography. Three months after surgery, the computed tomography coronary angiography showed no fistula, and the distal right coronary artery was bypassed with a saphenous graft. Thus, we concluded that in some instance multidetector-row computed tomography coronary angiography may be helpful for diagnosis and demarcation of coronary artery aneurysm with arteriovenous fistula. Key Words: Coronary arteriovenous fistula · Computed tomography INTRODUCTION Coronary artery aneurysm is an uncommon disease. Coronary artery aneurysm is defined as coronary dilata- tion that exceeds the diameter of normal adjacent seg- ment or the diameter of the patient’s largest coronary vessel by 1.5-2 times. 1 The incidence of this anomaly is between 1.4% and 5%. 2,3 Coronary artery aneurysm caused by coronary arteriovenous fistula is an even more uncommon condition. 4-7 Currently, multidetector-row computed tomography (MDCT) coronary angiography has become a valuable method for evaluation of coro- nary artery disease and the heart. 7-9 Herein, we report MDCT coronary angiography is helpful for demonstrat- ing a large right coronary aneurysm resulting from a cor- onary artery- to- right ventricle (RV) fistula. CASE REPORT A 52-year-old male suffered from effort-related chest tightness and palpitation for about 2 weeks. He had cardiac murmur and had been told he had heart disease by her family physician a long time before. He family history was unremarkable. He had a history of hyper- lipidemia (at admission, triglyceride measured 211 mg/ dl) and peptic ulcer for many years. On physical exami- nation, the patient appeared essentially well. However, a harsh grade 2-3/6 continuous murmur was audible over the left lower parasternal border. Chest radiography showed widening of the right mediastinum. Electrocardi- ography (ECG) showed left atrial enlargement and right bundle branch block. Transthoracic 2-dimensional and color-Doppler echocardiography showed mildly dilated left ventricle and aortic root, thick interventricular sep- tum, mild mitral and tricuspid regurgitations, and moder- ate aortic regurgitation. Furthermore, there was a large right coronary artery (RCA) orifice due to a suspected coronary arterio-venous fistula. Transesophageal echo- 47 Acta Cardiol Sin 2008;24:47-50 CT Showed a Right Coronary Aneurysm with Arteriovenous Fistula Case Reports Acta Cardiol Sin 2008;24:47-50 Received: July 21, 2007 Accepted: September 17, 2007 1 Departments of Radiology, 2 Cardiovascular Surgery, 3 Cardiology, Buddist Tzu Chi General Hospital, Xindian City, Taipei County, Taiwan. Address correspondence and reprint requests to: Dr. Kun-Eng Lim, Department of Radiology, Buddist Tzu Chi General Hospital, 289, Jiauguo Road, Xindian City, Taipei County, Taiwan, R.O.C. Tel: 886- 2-6628-9779 ext. 1100; Fax: 886-2-2546-1665; E-mail: kevinblueski @yahoo.com.tw
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Multidetector-row Computed Tomography in
Diagnosis of a Large Right Coronary Artery
Aneurysm Resulting from Arteriovenous Fistula
Kun-Eng Lim,1 Kuei-Ton Tsai2 and Yu-Lin Ko3
Coronary artery aneurysm with arteriovenous fistula is an uncommon condition. We report a 52-year-old male with
a large right coronary artery aneurysm resulting from a coronary artery-to-right ventricle fistula. The aneurysm and
the fistula were demonstrated by an electrocardiography-gated multidetector-row computed tomography coronary
angiography. Three months after surgery, the computed tomography coronary angiography showed no fistula, and
the distal right coronary artery was bypassed with a saphenous graft. Thus, we concluded that in some instance
multidetector-row computed tomography coronary angiography may be helpful for diagnosis and demarcation of
coronary artery aneurysm with arteriovenous fistula.