Clinical value of coronary artery-pulmonary artery fistula revealed by 64-slice spiral CT coronary angiography

Abstract

Objective To evaluate the value of the three dimensional multi-slice spiral CT in the diagnosis of coronary artery-pulmonary artery fistula (CPF) . Methods Retrospectively analyzed the multi-slice spiral CT images of 20 CPF patients diagnosed by coronary CT angiography. All of the cases were used in volume rendering, multiplanar reformation, curved planar reformation, and maximum intensity projection. Moreover, the incidence, the features of the abnormal vessels revealed by multi-slice spiral CT, and the diagnostic significance of CPF were retrospectively summarized. Results The origin of CPF vessels was the branch of left coronary artery or left conus branch in 11 cases, the branch of left coronary artery and right conus branch in 7 cases, the right conus branch in 1 case, and the multi-branch of left and right coronary artery in 1 case. The abnormal vessels demonstrated a tortuous dilatation in 19 cases and a tubular dilatation in 1 case. CPF extended into the pulmonary artery wall in 20 cases; companied with aneurysm in 5 cases and fusiform aneurysm in 1 case. Moreover, the pulmonary artery fistulas were located in the left wall of the main pulmonary artery in 14 cases, in the left anterior wall in 1 case, in the anterior wall in 2 cases, in the left and anterior wall in 1 case, and in the anterior and right wall in 1 case; pulmonary artery fistulas were absent in 1 case. The CT features of the pulmonary artery fistula concluded a window sign in 17 cases, an ejection sign in 8 cases, a smoke sign in 3 cases, a streamer sign in 1 case, and an isodensity sign in 10 cases. Conclusion The 3D-MSCT can clearly visualize abnormal vessels and fistula. Thus, this method can be considered as the primary choice in CPF diagnosis and treatment. Key words: Coronary disease; Pulmonary artery; Tomography, X-ray computed; Arterio-arterial fistula