BACKGROUND: Coronary-to-pulmonary artery fistulas are congenital coronary anomalies that are often incidentally found and no hemodynamic significance. They are abnormal vessels originating from the coronary artery and terminating into the pulmonary artery, with a tortuous pathway. However, coronary-pulmonary artery fistula associated with coronary artery aneurysm is a rare condition that can cause cardiac death.

CASE REPORT: A 55-year-old Thai woman diagnosed with traumatic aortic injury after being gored by a buffalo was incidentally found by computed tomography (CT) to have a coronary arteriovenous fistula with large aneurysm. One week after urgent thoracic endovascular aortic repair (TEVAR), she had a cardiac tamponade. Median sternotomy was performed for diagnosis and treatment. The final diagnosis was rupture of a large aneurysm of the coronary-pulmonary artery fistula (CPAF). No complications were found and the patient was discharged 2 weeks after surgery.

CONCLUSIONS: CPAF associated with rupture of a giant coronary aneurysm is a rare and life-threatening condition. Prompt diagnosis and emergency surgery are essential to treatment of these patients.

Keywords: Aorta, Thoracic, Cardiac Tamponade, Coronary Aneurysm, Coronary Vessel Anomalies, Aneurysm, Ruptured, Arteriovenous Fistula, Buffaloes, Coronary Artery Bypass, Incidental Findings, Pulmonary Artery, Thoracic Injuries, Tomography, X-Ray Computed, Wounds, Penetrating