Key result
Combined use of MDCT and SPECT imaging successfully detailed the anatomy of bilateral coronary fistulas and the degree of myocardial ischemia for clinical planning.
Case Report (n=1)
The combined use of MDCT and SPECT provides detailed anatomical and functional assessment of myocardial ischemia in patients with rare bilateral coronary fistulas.
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May support planning in rare bilateral fistulas; hypothesis-generating and should not yet change practice.
Coronary 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, thallium 201 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.
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Yang et al. (2012) conducted a case report in Bilateral communicating coronary arteriovenous fistulas (n=1). Multidetector computed tomography (MDCT) and single-photon emission computed tomographic (SPECT) imaging was evaluated. Combined use of MDCT and SPECT imaging successfully detailed the anatomy of bilateral coronary fistulas and the degree of myocardial ischemia for clinical planning.
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