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

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.