Neovascularization From Coronary Artery Leaking to Fungus Ball in the Lung
A 68-year-old woman came to the clinic for evaluation of an operation risk. She had the sensation of a mass in her abdomen for 10 years, and ventral hernia was diagnosed. Her weight was 96 kg and her height was 157 cm; her body mass index was 38.95 kg/m2. She had a history of diabetes for 3 years. She also had a history of aspergillosis, which had been cured 10 years ago. She reported no chest pain on exercise. Chest radiography demonstrated a fungus ball in the left upper lung (Figure 1). Radionuclide imaging (technetium 99m sestamibi scan) showed reversible, moderate-sized perfusion defects in the apical to mid-inferior area, suggesting right coronary artery lesion. The echocardiogram showed no abnormal findings. The coronary angiogram revealed neovascularization from the distal left circumflex artery and proximal right coronary artery to the left upper lung (Figure 2). There was no significant stenosis in the left and right coronary arteries. To confirm the site where the neovascularization leaked, we performed a multislice computed coronary angiogram. Axial images of the thorax in the mediastinal and lung settings showed close proximity between the left atrioventricular groove and a cavity mass. However, we failed to observe clear neovascularization flow because of the patient’s body fat and because the vessels had a very thin diameter. Instead, we confirmed a definite fungus ball in the left upper lung (Figure 3). We concluded neovascularity from both coronary arteries leaking to a fungus ball in the left lung.