Coronary artery fistula: 64-slice computed tomographic delineation and correlation with multiplane transesophageal echocardiography and surgical findings.

A 49-year-old female who presented with 3 weeks of exertional chest pain had an abnormal mediastinal finding at chest x-ray imaging. Conventional, nongated computed tomography of the chest revealed a "mass" in proximity to the right atrium. 64-slice, cardiac gated computed tomographic coronary angiography, and transesophageal echocardiography delineated the "mass" as a coronary artery fistula structure. The fistula originated from the left main as a tubular vessel that continued into an aneurysmal sac-like cavity that emptied into the superior vena cava near the right atrium. Computed tomographic coronary angiography showed otherwise normal coronary arteries. Findings were ultimately confirmed at cardiac catheterization. Coronary steal was clinically diagnosed and she underwent surgical ligation and resection of the fistula and aneurysm. Her subsequent course was uncomplicated.