Abnormal Coronary-bronchial Fistula: The Role of Coronary CT Angiography

Zaid Ammouri *

Cardiology department, CHU Ibn Rochd, Casablanca, Morocco.

S. Belkouchia

Cardiology department, CHU Ibn Rochd, Casablanca, Morocco.

S. Moussaoui

Radiology Department, CHU Ibn Rochd, Casablanca, Morocco.

H. Tazi

Cardiology Department, Mohamed VI University Hospital, Casablanca, Morocco.

R. Habbal

Cardiology department, CHU Ibn Rochd, Casablanca, Morocco.

*Author to whom correspondence should be addressed.


Background: Coronary-bronchial fistulas (CBFs) are rare vascular anomalies that involve abnormal connections between the coronary arteries and the bronchial tree. These anomalies can be challenging to diagnose due to their atypical presentation and the complexity of distinguishing them from other cardiovascular conditions.

Case Presentation: A 48-year-old man with a significant smoking history but no other cardiovascular risk factors presented to the emergency department with acute chest pain and shortness of breath. His initial clinical evaluation revealed elevated troponin levels, indicating myocardial injury. Given the patient's presentation and biomarkers, an urgent coronary angiography was performed to assess for possible coronary artery disease. The angiography revealed an unusual vascular structure, raising suspicion of a coronary-bronchial fistula (CBF).

Diagnostic Approach: To obtain a more precise anatomical understanding, a coronary CT angiography (CTA) was subsequently performed. The CTA provided detailed three-dimensional images, clearly delineating the abnormal fistulous connection between the coronary arteries and the bronchial tree. The high-resolution images allowed for a comprehensive assessment of the fistula's size, course, and its relationship with surrounding structures, confirming the diagnosis of a CBF.

Discussion: This case report illustrates the crucial role of advanced imaging techniques, particularly coronary CT angiography (CTA), in accurately diagnosing a CBF in a patient presenting with acute chest pain and elevated troponins. Our case highlights the essential role of coronary CTA in diagnosing coronary-bronchial fistulas, particularly in patients presenting with atypical symptoms and inconclusive initial imaging findings.

Conclusion: The integration of advanced imaging techniques, such as CTA, into the diagnostic workflow significantly enhances the ability to identify and characterize rare vascular anomalies.

Keywords: Coronary-bronchial fistula, coronary CT angiography, chest pain, troponins, vascular anomalies, diagnostic imaging

How to Cite

Ammouri , Zaid, S. Belkouchia, S. Moussaoui, H. Tazi, and R. Habbal. 2024. “Abnormal Coronary-Bronchial Fistula: The Role of Coronary CT Angiography”. Asian Journal of Cardiology Research 7 (1):111-16. https://journalajcr.com/index.php/AJCR/article/view/208.


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Sundaram B, Kreml R, Patel S. Imaging of coronary artery anomalies. Radiol Clin North Am. 2010;48(4):711- 727.

Fujimoto S, Kondo T, Orihara T, et al. Prevalence of anomalous origin of coronary artery detected by multi-detector computed tomography at one center. J Cardiol. 2011;57(1):69-76.

Ibrahim Al-Irr K. Complicated Coronary Artery Angiography with Transient Cortical Blindness. Cardiol. Angiol. Int. J. 2016 Apr. 23 [cited 2024 Jun. 8];5(2): 1-6. Available:https://journalca.com/index.php/CA/article/view/52

Alfawaz M, Alfawaz D, Alfawaz FA. Computed Tomography Coronary Angiogram; updates Regarding Evidence, Clinical Applications, and Emerging Technologies: A Literature of Review. J. Pharm. Res. Int. 2022 Mar. 21 [cited 2024 Jun. 8];34(25B):64-9. Available:https://journaljpri.com/index.php/JPRI/article/view/6113

Manning WJ, Li W, Edelman RR. A preliminary report comparing magnetic resonance coronary angiography with conventional angiography. New England Journal of Medicine. 1993 Mar 25;328(12): 828-32.

Manning WJ, Li W, Edelman RR. A preliminary report comparing magnetic resonance coronary angiography with conventional angiography. New England Journal of Medicine. 1993 Mar 25;328(12): 828-32.

De Jonge GJ, van Ooijen PM, Piers LH, et al. Visualization of anomalous coronary arteries on dual-source computed tomography. Eur Radiol. 2008;18(12): 2425-2432.

Narula J, Chandrashekhar Y, Ahmadi A, et al. SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr. 2021 May-Jun;15(3):192-217. DOI: 10.1016/j.jcct.2020.11.001.

Epub 2020 Nov 20.

PMID: 33303384

PMCID: PMC8713482.

Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn. 1990 Sep;21(1):28-40. DOI:10.1002/ccd.1810210110.

PMID: 2208265.

Pandey NN, Sinha M, Sharma A, Rajagopal R, Bhambri K, Kumar S. Anomalies of coronary artery origin: Evaluation on multidetector CT angiography. Clin Imaging. 2019 Sep-Oct; 57:87-98. DOI: 10.1016/j.clinimag.2019.05.010.

Epub 2019 May 23.

PMID: 31170598.

Malagò R, Pezzato A, Barbiani C, Alfonsi U, Nicolì L, Caliari G, Pozzi Mucelli R. Coronary artery anatomy and variants. Pediatr Radiol. 2011 Dec;41(12):1505- 15. DOI: 10.1007/s00247-011-2218-9.

Epub 2011 Nov 30.

PMID: 22127682.

Byun SS, Park JH, Kim JH, Sung YM, Kim YK, Kim EY, Park EA. Coronary CT findings of coronary to bronchial arterial communication in chronic pulmonary disease. Int J Cardiovasc Imaging. 2015 Jun;31 Suppl 1:69-75. DOI: 10.1007/s10554-015-0647-5.

Epub 2015 Mar 24.

PMID: 25802014.

Zenooz NA, Habibi R, Mammen L, Finn JP, Gilkeson RC. Coronary artery fistulas: CT findings. Radiographics. 2009 May-Jun;29(3):781-9. DOI:10.1148/rg.293085120.

PMID: 19448115.

Lim JJ, Jung JI, Lee BY, Lee HG. Prevalence and types of coronary artery fistulas detected with coronary CT angiography. AJR Am J Roentgenol. 2014 Sep;203(3):W237-43. DOI:10.2214/AJR.13.11613.

PMID: 25148179.

Shah SS, Teague SD, Lu JC, Dorfman AL, Kazerooni EA, Agarwal PP. Coronary to bronchial artery fistula: CT findings and review of the literature. J Thorac Imaging. 2015 May;30(3).DOI:10.1097/RTI.0000000000000132. PMID: 25333616.

Ko SM, Song MG, Hwang HK, et al. Coronary artery fistulas: pathophysiology, imaging findings, and management. Radiographics. 2019 May-Jun;39(3):790-804. DOI:10.1148/rg.2019180146.

PMID: 31059311.

Egbert JR, Kralovic DM, Andris A, et al. Comprehensive approach to coronary artery anomalies: The role of coronary computed tomography angiography. World J Radiol. 2016 Jul 28;8(7):682- 692. DOI: 10.4329/wjr.v8.i7.682.

PMID: 27551347

PMCID: PMC4977537.