Aorta-cameral fistulas: Spectrum of CT findings and review

  • Saurabh Agarwal
    Corresponding author at: Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI 02903, United States of America.
    Department of Diagnostic Imaging, Alpert Medical School at Brown University, Providence, RI 02903, United States of America
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  • Michael K. Atalay
    Department of Diagnostic Imaging, Alpert Medical School at Brown University, Providence, RI 02903, United States of America
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      • Aorto-cameral fistulas are important to recognize given the propensity to result in refractory heart failure, or even death.
      • Aorto-cameral fistulas are most commonly caused by ruptured sinus of Valsalva aneurysm or infective endocarditis.
      • Unlike intracardiac shunts where severity impacts whether to operate, repair of aorto-cameral fistulas is usually indicated.


      Aorto-cameral fistula (ACF) is an uncommon entity, defined as an abnormal communication between the aorta and a cardiac chamber. The most common causes include ruptured sinus of Valsalva aneurysm, infective endocarditis, traumatic injury, aortic dissection, or rarely can be iatrogenic in nature. While smaller communications may initially be asymptomatic, the natural course of these connections is generally refractory heart failure as they do not spontaneously heal. Larger fistulas can be life threatening with high mortality rates, and therefore once recognized, surgery is generally considered the treatment of choice. Diagnosis, however, can be challenging, and various imaging modalities are often used for diagnosis. This review highlights common underlying etiologies, clinical manifestations, and radiologic imaging appearances of ACF to each of the cardiac chambers of this uncommon, but clinically important entity, with emphasis on CT.
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