A case of acquired coronary cameral fistula mimicking coronary perforation during primary PCI

Coronary cameral fistulas are rare vascular anomalies, often congenital, with acquired cases being exceedingly uncommon. We report a case of a 73-year-old male presenting with ST-segment elevation anterior wall myocardial infarction (STEMI) complicated by cardiogenic shock. During primary percutaneous coronary intervention (PCI), a contrast blush was noted in the distal left anterior descending artery (LAD), raising suspicion of guidewire-induced coronary perforation which on careful evaluation was an incidentally detected coronary cameral fistula likely related to previous ischemia.