A Mediastinal Mass due to Coronary to Pulmonary Artery Fistula with a Giant Aneurysm Formation
A 64-year-old male with a congenital coronary artery to pulmonary artery fistula was admitted for evaluation of a mediastinal mass. A faint, high-pitched pansystolic murmur best heard in the second left intercostal space was changed by methoxamine into a continuous murmur. The phonocardiogram, echocardiogram and contrast-enhanced CT scan suggested a coronary artery fistula. It was confirmed by a selective coronary angiogram which revealed a giant oval aneurysm, corresponding to the localized bulging of the left cardiac border on X-ray. Surgical correction was successful. A fistulous aneurysm of a coronary artery should be considered in the differential diagnosis of a large mediastinal mass especially in the presence of a regurgitant heart murmur.