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Direct communication between the pulmonary artery and the left atrium (LA) is a rare congenital variation of arteriovenous fistula. Since its initial description by Friedlich et al. (1), approximately 60 cases have been reported in the literature and most of them involved communication from the right pulmonary artery to the LA (2). Most cases reported are of congenital origin, while some other cases appear to be of posttraumatic origin. A hemodynamic right-to-left (R-L) shunt may result in cyanosis, clubbing, dyspnea, polycythemia, and paradoxical systemic embolization (3, 4). In this study, we report an anomalous case involving direct communication between the left main pulmonary artery (LMPA) and the left atrial appendage, which was diagnosed by computed tomography (CT) and color Doppler echocardiography.

Direct Communication with Fistula between the Left Main Pulmonary Artery and the Left Atrium: A Case Report