# Giant Coronary-Pulmonary Artery Fistula Incidentally Detected in a Patient Presenting With Acute Inferior Myocardial Infarction

## TL;DR

A rare giant coronary-pulmonary artery fistula was found in a patient with a heart attack, highlighting the importance of imaging for detection and treatment.

## Contribution

Highlights the incidental detection of a giant coronary-pulmonary artery fistula during an acute myocardial infarction and its management challenges.

## Key findings

- A giant coronary-pulmonary artery fistula was detected in a 54-year-old woman with acute inferior myocardial infarction.
- The fistula could not be closed percutaneously and showed extensive aneurysms and calcifications on CTA.

## Abstract

Coronary artery fistulas are abnormal connections between the coronary arteries and the heart or other surrounding vascular structures. Although they are usually congenital, they can also occur iatrogenically or due to trauma. They are usually asymptomatic, but they can cause serious and even fatal complications. These complications include myocardial infarction, embolism, thrombosis, arrhythmia, and rupture. In a 54-year-old woman admitted to the emergency department with an acute inferior myocardial infarction, a giant coronary-pulmonary artery fistula was detected on angiography. The fistula could not be closed percutaneously, and computed tomography angiography (CTA) revealed extensive aneurysms and diffuse calcifications. Large fistulas should be closed due to the risk of rupture. Small fistulas should be detected by CTA, and radiologists should be familiar with the imaging features.