A case of ruptured aneurysm of coronary-pulmonary artery fistula diagnosed after emergency thoracotomy

BACKGROUND Coronary fistulae are occasionally detected using echocardiography or coronary angiography. We report a patient with cardiac tamponade because of a ruptured aneurysm of a coronary artery fistula. CASE PRESENTATION A 60-year-old man was referred to our hospital with sudden onset of chest pain and unconsciousness. He was initially diagnosed with cardiac tamponade for type A acute aortic dissection, and an emergency operation was performed. A large amount of bleeding was seen in the pericardium, but aortic dissection around the arch was not observed. Instead, a ruptured aneurysm of a coronary-pulmonary fistula was identified on the pulmonary artery root. The aneurysm was resected, and the fistula was closed by ligation. The patient's postoperative progress was good, and he was discharged on postoperative day 12 without any abnormalities on the coronary arteriogram. CONCLUSIONS Preoperative diagnosis of the rupture of the small coronary artery aneurysm is difficult in such an emergency case, and this possibility should be considered in differential diagnosis when the CT image does not show typical aortic dissection.