Coronary arteriovenous fistula presenting as chronic pericardial effusion.

We here describe the incidental finding of a rare type of anomalous coronary artery, originating from the right coronary sinus of Valsalva and draining into the right ventricle, in a 72-year-old woman admitted to our hospital with a history of chronic pericardial effusion. The presence of a coronary artery fistula was suspected on transthoracic echocardiography, but diagnosed with the use of transoesophageal echocardiography and coronary angiography. Angiography allowed delineating the origin and course of the fistula, and its drainage into the right ventricle.