Coronary artery fistula: assessment with multidetector computed tomography and stress myocardial single photon emission computed tomography.

Coronary artery fistula is an unusual coronary artery anomaly. Cardiac catheterization with coronary angiography remains the gold standard for the diagnosis of coronary artery fistula, but the physiologic significance and the relationship of coronary artery fistulas to other structures may not be apparent when it is investigated with this technique. Cardiac multidetector computed tomography and stress myocardial perfusion SPECT can be used as adjuncts to coronary angiography for anatofitinctional evaluation of this anomaly. We report the case of a 25-year-old mate patient with effort angina in whom cardiac multidetector computed tomography and dipyridamole Tl-201 myocardial SPECT were shown to play an important role in the noninvasive evaluation of coronary artery fistula and provide a physiology-based decision-making assessment for determining the need for intervention of such an anomaly.