Congenital aneurysm of a coronary artery with associated arterio-cameral fistula.

A 55 year old female, presented with atypical chest pain of 1 hour duration. On examination her vital parameters were normal and there was no gross cardiovascular abnormality. Electrocardiogram revealed slight ST depression in infero-lateral leads. On stress test there was slight increase in ST depressions. Chest skiagram and transthoracic echocardiogram were normal. On coronary angiography, left coronary vessels were normal. Right coronary artery (RCA) injection revealed stula arising from SA nodal artery with a tortuous path and terminating in right atrium. There was an additional fusiform aneurysm (A) of right ventricular (RV) branch of RCA and one branch of this has stulous communication to RV free wall (Figure 1).