Selective coronary arteriography, performed in a 67-year-old man with post-infarction angina, demonstrated severe three vessel disease and coronary fistulous communications with the left ventricular chamber adjacent to a giant mural thrombus formed in the apical aneurysm. Most of the contrast media seemed to empty directly into the chamber without presenting hypervascular blushes of the thrombus itself. This was somewhat different from the observation previously reported in a case with coronary fistulae associated with a post infarction mural thrombus. It was stressed that one should not misinterpret this condition as a rare coronary artery-cardiac chamber shunt associating myocardial infarction.