Coronary-pulmonary artery fistula is an uncommon cardiac anomaly, usually congenital. Most coronary-pulmonary artery fistulas are clinically and haemodynamically insignificant and are usually found incidentally. This report describes a case of complex coronary-pulmonary artery fistula with two feeding vessels of separate origins: one from the proximal part of the left anterior descending artery and another arising from the right aortic cusp. The complex anatomy of the fistula was shown in detail by multidetector computed tomography using multiplanar reconstruction and 3D volume rendering techniques.C oronary-pulmonary artery fistula (CPAF) was first described by Krause in 1865.1 It is a comparatively rare cardiac anomaly, characterised by a communication between a coronary artery having a normal origin from the aorta and a cardiac chamber or a large thoracic vessel such as pulmonary artery and superior vena cava. 2 The clinical presentation of CPAF is highly varied. Most patients, especially those with small fistulas are asymptomatic, and the lesion is discovered during coronary angiography performed for other reasons. Some of the CPAF can result in serious consequences including myocardial ischaemia or infarction, congestive heart failure, and sudden death.3 When complex anatomy or intervention is contemplated, conventional coronary angiography may not be sufficient. An ideal investigation technique should be non-invasive, safe, and provide a quality anatomical description of the fistula. We report a case of a fistula between the left anterior descending artery and the pulmonary artery in an asymptomatic adult subject diagnosed incidentally by multidetector computed tomography. The clinical case, imaging technique, and findings will be discussed. CASE REPORTA 58 year old asymptomatic man with intermediate risk for coronary artery disease was referred by his consultant cardiologist to our department for coronary computed tomography angiography. His physical examination was unremarkable. The electrocardiogram, chest radiograph, and transthoracic echocardiography were within normal limits. ECG gated coronary computed tomography angiography examination was performed using a 16-multidetector computed tomography scanner (1660.625 mm detector collimation, gantry rotation time 0.42 second, tube voltage of 120 kV, and pitch 0,26) (Lightspeed 16 Pro, General Electric Medical Systems).Images of the coronary arteries were reconstructed using curved multiplanar reformats, maximum intensity projection, and 3D volume rendering methods. Cardiac CT images showed a dilated left anterior descending artery coursing along the interventricular groove and terminating abruptly at the mid-interventricular groove, where multiple fine tortuous vessels arise. This vascular plexus formed a network that encircled the LAD and eventually coalesced to form a major dilated vessel that ran horizontally across the anteroinferior aspect of the pulmonary trunk before draining into the pulmonary trunk (figs 1 and 2). A few small vessels of the same ...

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