A man in his 50s was hospitalized for acute chest pain and dyspnea. As the diagnoses of left coronary-pulmonary artery fistula and cardiac tamponade were made, the patient underwent emergency surgery through a median sternotomy. After drainage of hemorrhagic pericardial effusion, a tortuous coronary artery fistula with a giant cauliflowerlike aneurysm was found, originating from the dilated left main trunk and wrapping around the main pulmonary artery before draining into it. The clot on the top of the aneurysm was identified as the rupture point. Surgical repair was successfully performed with aneurysm excision, fistula closure, and coronary artery bypass grafting.
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