Objective: To diagnosis the coronary fistula disease .Coronary artery fistulas are rare congenital or acquired coronary artery anomalies that can originate from any of the three major coronary arteries and drain in all the cardiac chambers and great vessels.
Method/Result: An 67-year-woman was referred for evaluation of an exertional dyspnoea. She reported recent history of few episodes of shortness of breath associated with moderate entity physical activity. At physical examination a mild continuous murmur could be heard mainly at the level of the second intercostal space of the left parasternal area. A transthoracic echocardiogram showed a continuous flow at color Doppler analysis wth enlargement of the proximal left anterior descending coronary artery in the high parasternal short axis view. A 64 cardiac MSCT revealed a fistula with severe aneurysmal dilatation connecting the proximal portion of the left anterior descending coronary artery with the main pulmonary artery.
Conclusion: A combination like the one described in the present case is rare since fistulas originate from the left coronary artery in about 30% of cases and drainage into the pulmonary artery occurs in only 15%.