Coronary artery fistula is a rare congenital or acquired anomalous shunt from a coronary artery to a cardiac chamber or great vessel. Most of them remain asymptomatic, however they can lead to ischemia, heart failure, arrhythmias as well as sudden cardiac death. This fistulas usually originates from the left anterior descending artery and drains into the main pulmonary artery. Coronary fistula draining to lung parenchyma was reported a few case.
A 59 year-old male patient admitted to the emergency department with the complaint of atypical chest pain. He was a heavy smoker and previously had been diagnosed with lung cancer. He was stage 4 squamous cell lung cancer. His blood pressure was 120/70mmHg and cardiac system examination was normal. Electrocardiography showed normal sinus rhythm with T wave inversion in leads DIII and aVF. Repated Troponin-I levels were in normal ranges. Echocardiography was normal. Coronary angiography showed no critical lesion on coronary arteries and fistula from circumflex coronary artery to pulmonary parenchyma (Figure 1a-b). Computerized tomography revealed this fistula is draining into the lung mass (Figure 1c).The patient underwent to myocardial perfusion sintigraphy (MPS) for further investigation to show ischemia. Due to the detection of ischemia in inferior wall, coil embolization was planned but the patient did not accept this theraphy.
To best of our knowledge, there are few cases fistulas from coronary artery to pulmonary parenchyma in the literature. However, there is no case report fistula from coronary artery to lung mass.
