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CASE REPORT   

Journal of Radiological Review 2020 September-October;7(5):382-7

DOI: 10.23736/S2723-9284.20.00045-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English, Italian

Coexisting complex coronary fistula and systemic arteriovenous fistula in a middle-aged long-distance runner: demonstration with coronary CTA

Mario FINAZZO 1 , Cristiana DURANTI 2, Valentina BONO 1, Francesca FINAZZO 2, Domenico MESSANA 2

1 Studio di Radiologia Finazzo, Palermo, Italy; 2 Department of Radiodiagnostics and Interventional Radiology, ARNAS Ospedale Civico, Palermo, Italy



Coronary fistula is an abnormal direct communication of coronary arteries with cardiac chambers or any segment of the systemic or pulmonary circulation. This communication typically skips the capillary network. We thereby describe a case of coronary to pulmonary artery fistula in a half-marathon middle aged runner which was identified by coronary CT angiography. The fistula involved a small vessels network arising from the ostium of the right coronary artery, the conus branch, the left main trunk and proximal subclavian artery and drained into the pulmonary trunk. Moreover, another fistula was detected involving a tangle-like vascular malformation around right pulmonary hilum. It was an arterio-venous fistula arising from a hypertrophic bronchial artery and draining into the superior caval vein. Although it is not uncommon (5% of cases) that a coronary to pulmonary fistula arise from both the coronary arteries, to our knowledge, the involvement of the left subclavian artery and the coexisting presence of a systemic fistula have never been reported in literature. This case report confirms the robustness of coronary CT angiography in the assessment of coronary fistula, as it provided all the information required for a proper management of such condition. Moreover, coronary CT angiography might be used to identify patients with high risk of major cardiac events amongst long distance runners with equivocal symptoms, as ECG and treadmill exercise testing may fail to detect this class of patients.


KEY WORDS: Arteriovenous fistula; Computed tomography angiography; Subclavian artery; Running

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