The significance of aneurismal dilatation in diagnosing coronary artery fistula by CT angiography

CAO Zhi-jian; XU Mao-sheng; CHEN Zhi-neng; DING Guo-miao; WA NG Shi-wei; CHEN Gang

Abstract：Objective To investigate the clinical significance of coronary aneurismal dilatation in diagnosing coronary ar‐tery fistula (CAF) by CT angiography (CTA) .Methods Totally ,10460 cases underwent coronary CTA were retrospec‐tively reviewed .Electrocardiography gated 64‐slice cardiac CT scans were performed .Postprocessing techniques included volume rendering technique (VRT) ,multi‐planner reformation (MPR) and maximum intensity projection (MIP) .The findings of CAF especially aneurismal dilatation were analyzed .Results 21 cases of CAF (0 .20% ) were detected by CTA in 10460 patients .The communication of the fistula included coronary artery to left atrium (2 cases) ,to left ventricle (2 cases) ,to pulmonary artery (16 cases) ,and to pulmonary artery and left ventricle (1 case) .Feeding coronary artery dila‐tations were noted in all 21 cases of CAFs .Eighteen aneurismal dilatations were detected in 17 cases of CAF (80 .9% ) . The morphologic finding of aneurismal dilatation was fusiform (2 cases) and saccular (15 cases) .The location of the aneu‐rismal dilatation was near (8 cases) and not near (9 cases) by the fistula .Mural thrombus was noted in 1 case .Conclusion It’s very helpful for diagnosis of CAF by carefully investigating the findings of aneurismal dilatation in CT angiography . Coronary CTA is capable of displaying the fistulas ,the aneurysms ,and the mural thrombus within the aneurysm sac , which can provide important reference for the planning of CAF treatment .