The Teaching Point

Cardiac computed tomography may play an important role in the diagnosis of a coronary-cameral fistula with multiplanar reconstructions and maximum intensity projection image reformats detecting its origin, course, morphology and termination but also its relation with the adjacent anatomic structures, while volume rendering technique images offer an impressive overview of the fistula that would be helpful for surgical planning. With cardiovascular magnetic resonance we can measure the blood flow volume within the coronary-cameral fistula`s lumen and have additional detailed information about the cardiac function and morphology of the cardiac chambers as well as the myocardial wall viability that may be of crucial importance for the prognosis of these patients.






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From the manuscript

Cardiovascular magnetic resonance and computed tomography in the evaluation of aneurysmal coronary-cameral fistula

Free full text article: Cardiovascular magnetic resonance and  computed tomography in the evaluation  of aneurysmal coronary-cameral fistula

Abstract
Coronary artery fistulas represent abnormal communications between a coronary artery and a major vessel like venae cavae, pulmonary arteries or veins, the coronary sinus, or a cardiac chamber. The latter is called coronary cameral fistula is a rare condition and is most of the times congenital but can be also post traumatic or post surgical, especially after cardiovascular interventional procedures. Most patients are asymptomatic and coronary-cameral fistulae are discovered incidentally during angiographic evaluation for coronary vascular disorders, while other patients have a clinical presentation ranging from angina pectoris to heart failure. In this article, we report a rare case of an aneurysmal right coronary cameral fistula draining into the left ventricle. Echocardiography usually represents the first diagnostic imaging approach, but often due to a poor acoustic window may not show the entire course of the fistula which is crucial for the final diagnosis. ECG-gated cardiovascular CT may play an important role in the evaluation of the origin, course, termination and morphology of the fistula, its relation to the adjacent anatomical structures as well as the morphology and contractility of the heart. Cardiac MRI instead plays an additional crucial role regarding not only the above mentioned factors but also in estimating the blood flow within the fistula, providing more detailed information about the cardiac function but also about myocardial wall viability.






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