CASE REPORT PEER REVIEWED | OPEN ACCESS www.edoriumjournals.com International Journal of Case Reports and Images (IJCRI) International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties. Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.com Rare congenital cardiac anomaly presenting with predominant respiratory complaint: A case report Sheetal Chaurasia, Ravi Kumar, Alamelu Haran, Srikanth Katare ABSTRACT Introduction: Coronary cameral fstula is a rare anomaly where there is a fstulous connection between coronary artery and one of the cardiac chambers. It generally presents with predominant cardiac complaints or as accidental fnding in an asymptomatic individual. Our patient presented chiefy with respiratory complaint and was misdiagnosed as tuberculosis. Case Report: A 22-year-old female presented in chest OPD with complains of cough and fever since one month and was started on anti-tubercular treatment since one month. On examination there was continuous murmur, thrill and coarse crackles in right axillary area. On Chest X-ray there was a multi-lobulated mass in the right side with upper zone linear and cystic opacities. Computed tomography (CT) scan of Thorax showed right middle lobe bronchiectasis and a large fstula arising from right coronary artery and draining into right superior pulmonary vein and left atrium. Cardiac catheterization confrmed the diagnosis and coronary arteriovenous fstula closure was done by percutaneous route via lifetechcera vascular plug. Conclusion: Coronary cameral fstula despite being large in size may remain silent without causing any hemodynamic abnormality or any compromise in the cardiac function. The predominant complaint may be due to pressure effect of the aneurysmal vessel on adjacent bronchi and causing secondary changes in the pulmonary parenchyma fed by these bronchi. A thorough clinical examination may clinch the diagnosis (This page in not part of the published article.)