Coronary Pulmonary Fistula: A Rare Case Presenting with Recurrent Chest Pain

Background: Coronary pulmonary fistula is a rare clinical entity. Majority of them are clinically silent. But rarely chest pain, myocardial ischaemia and heart failure may be the presenting features. Coronary artery fistulas originate predominantly from the right coronary artery and are not associated with hemodynamic abnormalities or other congenital heart diseases. Case Presentation: Here we present a case of 41 years male presenting with recurrent chest pain for the last 2 years which had increased in frequency for last couple of days. Repeated Chest x rays, electrocardiograms and echocardiography being normal. Lastly this case was diagnosed by CT coronary angiography which revealed normal caliber left and right coronary arteries but abnormal torturous plexus of vessels seen to arise from proximal part of left anterior descending artery finally communicating with pulmonary trunk suggestive of coronary pulmonary fistula. Learning objective: Above case depicts an anomaly of coronary artery underdiagnosed since long time in many clinical scenarios in which patient might have repeated episodes of angina and this should be kept mind as a possible differential and CT angiography proves to be diagnostic in identifying the anomalous vessel with its origin and communications.