Abstract
BACKGROUND: This clinical vignette demonstrates the use of echocardiography and coronary computed tomography angiography (CTA) in establishing a rare diagnosis. CASE SUMMARY: We present the case of a 16-year-old young woman with a novel congenital anomaly involving a complex fusion fistula connecting the internal mammary artery, pulmonary vein, coronary artery, and pulmonary artery. Her complex coronary artery-pulmonary artery anomaly was carefully observed under monitoring by coronary CTA and echocardiography, with no interventional approach owing to lack of coronary steal or left-to-right shunt. TAKE-HOME MESSAGE: Multimodal imaging, including coronary CTA and echocardiography, is useful for diagnosing and monitoring complex coronary arteriovenous fistulas.