The evaluation of coronary artery-to-pulmonary artery fistula in adulthood on 256-slice CT coronary angiography: Comparison with coronary catheter angiography and transthoracic echocardiography.

Abstract

OBJECTIVE:

To review the imaging features of coronary artery-to-pulmonary artery fistula (CPAF) on CT coronary angiography (CTCA) and evaluate its diagnostic performance compared with coronary catheter angiography (CCA) and transthoracic echocardiography (TTE).

MATERIALS AND METHODS:

We retrospectively reviewed with a diagnosis of CPAF from among 19855 consecutive CCTA performed with 256-slice MDCT scanner for suspected coronary artery disease. CT images were evaluated for - origin, number, size and course (tubular/worm-like dilation/significant aneurysm formation/wall attachment sign) of fistula vessels, drainage site, drainage site imaging features (pierced sign, isodensity sign, smoke sign, jet sign), and main pulmonary artery (MPA) enlargement. 25 patients of CPAF also underwent CCA and 47 patients underwent TTE.

RESULTS:

There were 72 patients with CPAF (0.36%) in our study, of which 44 were men and 28 were women, with mean age of 55.8 ± 13.2 years (range 22-85 years). CPAF originated from conus artery, left anterior descending artery (LAD), combined conus artery and LAD in 55, 67, 50 cases, respectively. Tubular dilation, worm-like dilation and aneurysm was seen in 14, 58 and 35 cases, respectively. Wall attachment sign was noted in 69 cases. All the cases demonstrated only a single drainage site, with left lateral wall, left anterolateral, anterior, right lateral and right anterolateral walls of MPA in 44, 21, 5, 1 and 1 cases, respectively. The mean diameter of the fistula drainage site was 2.6 ± 1.3 mm. Pierced sign, jet sign, smoke sign, isodensity sign was seen in 72, 46, 41 and 24 cases, respectively. MPA enlargement was seen in 20 patients. CCA showed CPAF in only 20 cases among 25 patients; while TTE showed CPAF in only 9 patients among 47 patients.

CONCLUSION:

CTCA is competent in detecting and characterizing CPAF with an excellent diagnostic performance as the first imaging modality of choice, which is valuable for giving a distinct and intuitive explanation to patients and physicians and making an objective and exact assessment for further management.

• Authors: Jing-Lei Li, Lei Huang, Wei Zhu, Wei-Tao Ye, Li-Fen Yan, Xiao-Mei Zhong, Hai-Ying Luo, Sachin Saboo, Mei-Ping Huang, Chang-Hong Liang
• Journal: Journal of cardiovascular computed tomography (J Cardiovasc Comput Tomogr) 2019 Jan - Feb Vol. 13 Issue 1 Pg. 75-80 ISSN: 1876-861X [Electronic] United States
• PMID: 30366860 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2019 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Arterio-Arterial Fistula (diagnostic imaging, physiopathology)
• Computed Tomography Angiography (methods)
• Coronary Angiography (methods)
• Coronary Circulation
• Coronary Vessel Anomalies (diagnostic imaging, physiopathology)
• Coronary Vessels (diagnostic imaging, physiopathology)
• Echocardiography (methods)
• Female
• Humans
• Male
• Middle Aged
• Multidetector Computed Tomography (methods)
• Predictive Value of Tests
• Pulmonary Artery (abnormalities, diagnostic imaging, physiopathology)
• Pulmonary Circulation
• Reproducibility of Results
• Retrospective Studies
• Young Adult