Coronary artery aneurysm and fistula

Case contributed by Craig Hacking


Abnormal coronary angiogram post removal of infected ICD.

Patient Data

Age: 60-65 years
Gender: Female

Coronary Angiography

Origins: Normal

Dominance: Right

Left Main Coronary Artery (LMCA): Calcification in the distal LMCA noted.

Left Anterior Descending (LAD): Calcification in proximal and middle segments of the vessel.

1st diagonal branch (D1) normal

D2 - not identified due to afore mentioned technical limitations.

Circumflex artery (Cx): The circumflex artery is of small caliber. It is opacified for a short (approximately 1 cm ) segment as it runs laterally into a 2.5 x 3.1 pocket of contrast in keeping with a large pseudoaneurysm. This is continuous inferiorly with the great cardiac vein which is distended as is the coronary sinus, the small and the middle coronary veins. The remainder of the left circumflex and its branches are not opacified.

Right Coronary Artery (RCA): Moderate partially calcified plaque in the proximal and middle segments and a small focus of non calcified plaque in the distal segment.

Posterior descending artery (PDA) - Patent

Posterior left ventricular branch (PLV) - large and patent.

Cardiovascular Findings:

The inferolateral wall of the left ventricle is hypodense suspicious for a region of acute infarction. Wall thinning with fatty metaplasia is present in a smaller region along the anterolateral wall and also at the apical inferior wall.

There is a small pericardial effusion. The right atrium is moderately enlarged in keeping with the known moderate tricuspid regurgitation on recent echo. Reflux of contrast into a large IVC.

A small amount of calcification in the aortic valve is present.

Bilateral small pleural effusions and mild bibasal atelectasis.


Large (3 cm) pseudoaneurysm arising from left circumflex artery which then has fistulous connection with the great cardiac vein. No opacification of the left circumflex artery distal to the fistula.

Case Discussion

Good case of wall ischemia due to a fistula.

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