Non-invasive recognition of generalized coronary arteriosystemic fistulae by contrast echocardiography and multidetector CT.

Coronary artery fistulae, including generalized coronary arteriosystemic fistulae, are usually identified incidentally during invasive coronary angiographies. Generalized or multiple coronary arteriosystemic fistulae arise from all three major coronary arteries draining into the left ventricular chamber. In a patient with generalized coronary arteriosystemic fistulae, myocardial ischemia and diastolic volume overload of the left ventricle can be caused by a left-to-left shunt; however, the clinical and hemodynamic consequences are incompletely understood. We report the case of generalized coronary arteriosystemic fistulae in a 73-year-old female who presented with mild exertional dyspnea as an anginal equivalent. This case report represents the complementary, non-invasive role of transthoracic contrast echocardiography and multidetector computed tomography (MDCT) coronary angiography in the early recognition of generalized coronary arteriosystemic fistulae by demonstrating a plexus of multiple small vessels emptying exclusively into the left ventricle.