Figure 8a. Preoperative assessment for mitral valve replacement and CABG in a 43-year-old woman who had undergone placement of an automatic implantable cardioverter/defibrillator. Physical examination revealed a continuous murmur over the left side of the chest. (a) Axial CT scan shows enlargement of the left internal mammary artery and vein. Note enhancement of both dilated internal mammary artery and vein (arrow). (b) Coronal MIP image shows the dilated, fistulous internal mammary artery and vein (arrow).