Rupture of a giant saccular aneurysm of coronary arteriovenous fistulas

A 58-year-old Japanese woman was admitted to our hospital because of chest pain. A continuous murmur was detected at the left parasternal area. Electr ocardiogram showed ST elevation in leads V-2, V-3 and V-4. Chest computed t omography and echocardiography demonstrated pericardial effusion and a larg e mass which was adjacent to the pulmonary artery. An abnormal blood flow w as detected in the mass by Doppler echocardiography. Coronary angiography c onfirmed that the mass was a giant aneurysm of coronary arteriovenous fistu la arising from both the left and right coronary arteries. This patient had no symptoms until rupture of the fistula. Rupture of a coronary arterioven ous fistula is very rare but can be a cause of chest pain and pericardial e ffusion.