Coronary artery fistula is a relatively rare finding in patients undergoing diagnostic cardiac catheterization. Incidence, angiographic characteristics and natural history of coronary fistulas of this type have not been well defined in the literature. We report a case of a 54-year-old man in whom such abnormalities have been diagnosed with invasive and non-invasive coronary imaging and review the epidemiology, treatment and prognosis of coronary fistulas.