Complex coronary fistula with feeder aneurysm: 64 MDCT findings correlated with conventional angiography

44 year old male was admitted to hospital with chest pain. Complex coronary artery fistula drained into pulmonary artery was depicted but not clearly demonstrated with conventional angiography despite various projections. CT angiography was demonstrated that the fistula was fed by both left anterior descending (LAD) and right coronary artery (RCA) branches. A feeder aneurysm was found on a LAD branch. The fistula was associated with RCA and LAD artery via small caliber vessel web which was also associated with right ventricular outlet. 64-MDCT is superior to catheter angiography in its capability to demonstrate beyond the lumen of coronary arteries and extra-anatomical structures like fistulas.