Cardiac tamponade due to rupture of coronary artery fistulas with a giant aneurysm containing a free floating ball thrombus: a case report.

A 76-year-old woman was admitted to our hospital with cardiac tamponade. Chest computed tomography revealed a large tumor adjacent to the pulmonary artery, the center of which was demonstrated as a high density area without contrast medium. Coronary angiography revealed a large aneurysm consisting of coronary artery fistulas. An afferent vessel connected tangentially to the surface of the aneurysm, so blood flowed around along the inner wall of the aneurysm. A filling defect was demonstrated in the center of the aneurysm that indicated a thrombus. The cause of cardiac tamponade was seemed to be bleeding of the coronary artery fistulas. Coil embolization was performed, but recanalization occurred. Therefore, ligature of the fistulas and aneurismal resection were performed using a cardiopulmonary bypass. A fresh floating thrombus was found in the aneurysm.