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Rare disease
CASE REPORT
A case of congenital coronary-pulmonary fistulas presenting as spontaneous mediastinal haemorrhage
  1. Guramrinder Singh Thind1,
  2. Yashwant Agrawal1,
  3. Jagadeesh K Kalavakunta2,
  4. Robert Lapenna2
  1. 1 Department of Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan, USA
  2. 2 Borgess Medical Center/Michigan State University, Kalamazoo, Michigan, USA
  1. Correspondence to Dr Guramrinder Singh Thind, guramrinder.thind{at}med.wmich.edu

Summary

Coronary artery fistulas are rare anomalous vascular connections between coronary arteries and a cardiac chamber or a central vessel, without an intervening capillary bed. Coronary-pulmonary fistulas are a distinct subset of coronary artery fistulas. We present the case of a previously healthy 63-year-old-man who presented with chest pain and was found to have mediastinal haemorrhage. Upon further investigations, he was found to have multiple coronary-pulmonary fistulas with pseudoaneurysm formation in three of the fistulas. Two of these pseudoaneurysms showed inflammatory changes indicative of recent bleed. These were determined to be the source of the mediastinal bleeding and patient’s initial presentation. The patient was managed medically after obtaining multiple expert opinions from various institutions.

  • cardiovascular medicine
  • interventional cardiology

https://doi.org/10.1136/bcr-2017-221282

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    Footnotes

    • Contributors All authors contributed to the manuscript as follows. GST and YA were both part of the team that admitted the patient. RL and JKK were part of the cardiology team that evaluated the patient. Hence, all authors were directly involved with patient care. GST and YA did the literature review and manuscript write-up. RL and JKK revised the manuscript critically for important intellectual content. All authors gave their final approval of the version to be published.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.