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Acute coronary syndrome in a patient with a large inter-communicating coronary vascular malformation: imaging with 320-slice CT
  1. Wai-ee Thai,
  2. Ian T Meredith,
  3. Philip M Mottram
  1. Monash Cardiovascular Research Centre, MonashHEART, Southern Health & Department of Medicine (MMC), Monash University, Melbourne, Australia
  1. Correspondence to Dr Wai-ee Thai, Non-Invasive Cardiac Imaging Fellow, Monash Heart, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia; waiee{at}hotmail.com

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A 49-year-old woman presented with central chest discomfort associated with anterior T-wave inversion and raised troponin I concentrations consistent with an acute coronary syndrome. Invasive coronary angiography revealed only minor non-obstructive coronary disease; however, a large poorly defined vascular malformation was identified. Multidetector (320-slice) cardiac CT defined a large left-sided arterial vascular malformation with multiple fistulous channels between the left anterior descending and right coronary arteries (figure 1), and a single point of drainage into the proximal pulmonary artery. Echocardiography revealed normal left heart chamber volumes and pulmonary artery systolic pressure, consistent with a non-haemodynamically significant shunt. The acute coronary syndrome was postulated to be secondary to an embolic source from the arterial vascular malformation. The patient was …

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