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A coronary artery fistula with a giant aneurysm.

A 69-year-old woman presented to the emergency department with a one-month history of general fatigue and shortness of breath. Chest radiography (Picture A) showed a prominent bulge in the third arch of the left heart border. Contrast-enhanced computed tomography (CT) indicated a giant coronary aneurysm with a diameter of 5 cm (Picture B). Right cardiac catheterization revealed a 7.5% increase in the PA of O2 saturation and confirmed the presence of a fistula. Surgical resection of the fistula and the aneurysm improved the patient’s symptoms (Picture C). Coronary artery fistulae are rare cardiac malformations (1). The development of symptoms typically depends on the volume of the shunt or the presence of a coronary steal, which may result in the formation of coronary artery aneurysms. Giant coronary aneurysms are considered to be very rare; however, advancements in imaging modalities, especially CT, have indirectly increased the detection rates of these lesions (2).