Prevalence, morphology, and management of coronary cameral fistulas detected on cardiac CT: a multicenter study.

This study aimed to assess the prevalence, morphology, and clinical outcomes of coronary cameral fistulas (CCFs) detected on cardiac computed tomography (CT) at three tertiary centers. We retrospectively reviewed 22,641 patients who underwent cardiac CT between January 2012 and July 2025. The CCF cases were identified through a PACS search. Two radiologists independently assessed the origin vessel, drainage site, fistula number, and diameter. The clinical data was obtained from electronic medical records. The CCFs were identified in 15 patients; 14 were analyzed after excluding one patient who lacked preoperative imaging. Seven (50.0%) patients were symptomatic at diagnosis. Two (14.3%) patients had dual coronary origins, totaling 16 origin vessels. Of the 16 origin vessels, the right coronary artery was the most common (n = 6, 42.9%). The drainage sites included the left ventricle (35.7%), right atrium (28.6%), right ventricle (21.4%), and left atrium (14.3%). The median maximal fistula diameter was 4.2 mm; the surgical patients (n = 4, 28.6%) had significantly larger fistulas. During a 19-month median follow-up, no CCF-related adverse cardiac events occurred. The CCFs are rare anomalies identified on CCTA (prevalence of 0.07%). Surgical patients had larger fistula dimensions than conservatively managed patients, and no CCF-related adverse cardiac events occurred during midterm follow-up.