A rare case of coronary fistula evaluated by first-pass radionuclide angiography.

Coronary artery fistula (CAF) is a rare anomaly that originates from the coronary artery and drains into the cardiac chamber or the adjacent vasculature. We report a case of CAF in a 77 years old woman with dyspnea on exertion. Using coronary angiography and cardiac multidetector computed tomography, this patient was diagnosed with CAF draining into the left bronchial arteries. First-pass radionuclide angiography (FPRNA) showed early pulmonary recirculation through a left to right shunt. The pulmonary to systemic blood flow ratio was 1.24. The patient received supportive care with vasodilator and antiplatelet therapy. First-pass radionuclide angiography was used to provide physiologic informations, to plan the treatment course for this patient.