Purpose or Case Report: 10-year-old male presented with intermittent fever, cough, shortness of breath, and weight loss. Contrast CT chest performed showed pulmonary thrombus in the right lower lobe branch with necrotizing cavitary pneumonia of the right lower lobe. Dilation of the left coronary artery (LCA) was noted on the chest CT and hence dedicated CT coronary angiography was performed. On CT coronary angiography, there was dilation of the proximal LCA with a wide caliber fistula arising from the LCA, proximal to its bifurcation. The fistula coursed in a retroaortic manner, draining into the right atrium posteriorly at the superior cava-atrial junction. Blood culture showed HACEK organism which is known to be associated with endocarditis. The echocardiogram showed possible vegetation attached to the left side of the atrial septum. After the patient was medically treated with intravenous antibiotics, successful ligation of the fistula was performed at its insertion to the right atrium.
We will discuss in detail as well as illustrate the CT coronary angiography findings in this patient using MIP and 3D reconstructions. We will also describe the types of coronary cameral fistula in detail
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