A case of an aneurysm associated with four coronary artery fistulae originating from three vessels is reported. The patient, a 52-year-old woman, had chest heaviness and palpitations. Coronary arteriography revealed the four fistulae originating from three coronary vessels with an aneurysm draining into the left ventricle and the main pulmonary artery. The patient's symptoms were relieved after fistulectomy and the aneurysmectomy, suggesting that a coronary steal phenomenon through the fistulae was the cause of her symptoms. This case is of interest because of its rarity, since this is the first case report of an aneurysm associated with four coronary artery fistulae from three vessels.