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J Cardiovasc Med (Hagerstown). 2013 Jul 12. [Epub ahead of print]

Dolicho-right coronary artery emptying in coronary sinus: a rare, 'snake-like', giant coronary fistula.

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  • 1aRadiology, Monaldi Hospital, Naples bCardiology, Second University of Naples, Monaldi Hospital, Naples cCardiology, Monaldi Hospital, Naples, Italy.


A 41-year-old asymptomatic Italian male underwent cardiologic screening before blood donation. A transthoracic echocardiogram showed a huge right coronary artery (RCA) aneurysm continuing into a very twisted, worm-like channel, apparently draining into the right atrium (RA), suggesting the diagnosis of RCA-RA coronary fistula. Multidetector computed tomography showed a mild dilatation of the proximal RCA that gave rise to a giant 'snake-like' aneurysm (6.6 × 7 cm) followed by a long, tortuous and circumvolved channel spreading all over the right atrium and right ventricular free wall and finally draining into the coronary sinus.

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