Bilateral coronary artery–pulmonary artery fistulas with a giant coronary aneurysm

A 61-year-old female patient visited the local hospital 1 month before due to lumbar disc herniation and sciatic nerve compression. After treatment with “mannitol and dexamethasone” by intravenous infusion, she had dizziness, palpitations, flushing, and sweating, among other symptoms. Her blood pressure was 150/87 mm Hg, and the abovementioned symptoms lasted for about half an hour. After 3 days of infusion, the patient still experienced dizziness, palpitations, and sweating; her symptoms relieved about half an hour after administering nitroglycerin. These symptoms often occurred between 7 and 9 a.m. and had nothing to do with the patient’s daily activities or eating habits. The patient was referred to our hospital for further treatment. The electrocardiogram was normal, and transthoracic color Doppler echocardiography (TTDE) showed left coronary artery–pulmonary artery fistula and left coronary artery aneurysm dilation (Fig. 1a and 1b).