Giant Aneurysm of the Left Circumflex Coronary Artery with Fistulous Communication to the Right Atrium: Multimodal Cardiac Imaging

Abstract

A healthy 36-year-old man visited his family doctor with abdominal discomfort. Electrocardiogram revealed right-axis deviation and a continuous murmur was heard at the third intercostal space left sternal border. Transthoracic echocardiogram demonstrated a continuous color jet draining into the enlarged right atrium (RA). Subsequent cardiac computed tomographic images and coronary angiogram revealed a giant left main trunk and left circumflex coronary artery (LCx) with intraluminal thrombi and fistulous communication to the RA. Cardiac magnetic resonance imaging measured a Qp/Qs of 1.24. A multimodal imaging approach helped diagnose this rare cameral fistula (LCx-to-RA) complicated by giant coronary aneurysm and intraluminal thrombi.