Tiny ruptured coronary aneurysm with coronary-pulmonary arterial fistula.

A 44-year-old man was admitted to our hospital with chest pain. We diagnosed him with pericardial effusion collection because of a spontaneous ruptured coronary aneurysm of 1.5 cm with coronary pulmonary arterial fistula (CPAF) by enhanced computed tomography and angiography. We completely resected the ruptured aneurysm and safely closed the CPAF. Rupture of coronary aneurysms with CPAF is rare, especially tiny aneurysms. In previous reports, most cases were older women and the diameter of the ruptured aneurysms was greater than 3.0 cm. We report a case of a middle-aged man with a tiny ruptured coronary aneurysm with CPAF.