CASE 13167 Published on 28.11.2015
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Fistula Between Right Coronary Artery and Left Atrium via Sinoatrial Artery: A Rare Entity

Section

Cardiovascular

Case Type

Anatomy and Functional Imaging

Authors

Onur Taydaş, Yasin Erarslan, Banu Evrenos, Tuncay Hazırolan

Ankara; Email:onur.taydas@hacettepe.edu.tr
Connected authors
Patient

57 years, male

Categories
Area of Interest Cardiovascular system, Cardiac ; Imaging Technique CT-Angiography
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Clinical History
A 57-year-old male patient with symptoms of intermittent chest pain was admitted to our hospital. Physical examination revealed hypertension. Transpoesophageal echocardiography and electrocardiography was nonspecific.
Imaging Findings
ECG gated multidetector computed tomography (MD-CT) angiography was performed for evaluation to coronary arteries. MD-CT showed high grade stenosis in right coronary artery (RCA). Sinoatrial artery which was a branch of right coronary artery (RCA), fistulated to the left atrium after passed through the junction of superior vena cava and right atrium. The fistula did not have high volume.
Discussion
There are not any cases in literature about the fistula between the sinoatrial artery and the left atrium. Coronary artery fistula is the communication between a coronary artery and a cardiac chamber, great artery or vena cava [1]. The incidence of coronary artery fistulas is 0,3–0,8% in angiographic series and arises from the right coronary artery in 55% of cases. Fistulas drain into the right ventricle in 41%, right atrium in 26%, pulmonary artery in 17%, left ventricle in 3%, and superior vena cava in 1% of cases [2]. Coronary artery fistulas are usually asymptomatic in adults. Symptoms mainly depend on the severity of shunt. The major clinical risk in adults is myocardial infarction due to decreased coronary blood flow distal to the fistula even if there is no evidence of coronary atherosclerosis [3].
Differential Diagnosis List
Fistula between right coronary artery and left atrium via sinoatrial artery
Coronary arteriovenous fistula
Ruptured sinus of Valsalva aneurysm
Ventricular septal defect with aortic insufficiency
Final Diagnosis
Fistula between right coronary artery and left atrium via sinoatrial artery
Case information
URL: https://eurorad.org/case/13167
DOI: 10.1594/EURORAD/CASE.13167
ISSN: 1563-4086
License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Figure 1

VRT image

VRT image
Cardiac CT angiography volume-rendered image shows sinoatrial artery which is a branch of right coronary artery (RCA) and fistulates to the left atrium.
Figure 2

MIP image

MIP image
Cardiac CT angiography maximum intensity projection image shows sinoatrial artery which is a branch of right coronary artery (RCA), fistulates to the left atrium.