Bilateral communicating coronary arteriovenous fistulas presenting with recurrent angina

AbstractCoronary fistula is a rare disorder. Early diagnosis is difficult because angina caused by stenosis secondary to coronary atheroma is very similar to the coronary steal phenomenon. We report the case of a 51-year-old man who presented with recurrent angina over an 8-year period in whom bilateral coronary fistulas were detected by conventional coronary angiography. Sixty-four-slice multidetector computed tomography (MDCT) showed bilateral coronary fistulas merging to form an aneurysm before entering the pulmonary artery. However, thallium201 single-photon emission computed tomographic (SPECT) myocardial perfusion imaging showed only inferior apical ischemia. The combined use of these techniques showed the detailed anatomy of the fistula and the degree of myocardial ischemia for clinical planning. Both MDCT and SPECT are important diagnostic tools and should be considered in the clinical evaluation of bilateral coronary fistulas