Multimodality imaging of a left main coronary artery-to-pulmonary artery fistula

We report a case of a 17-year-old young man with a coronary fistula incidentally diagnosed. On transthoracic echocardiography, an abnormal flow draining into the pulmonary trunk was evidenced. Coronary computed tomography confirmed the presence of a small coronary fistula connecting the proximal part of the left anterior descending artery to the pulmonary trunk. As the patient was completely asymptomatic, in order to guide the clinical management and exclude any underlying ischemic phenomena, the patient underwent stress myocardial perfusion scintigraphy which was negative for ischemia.