Complex cardiac vascular malformation: Natures own CABG

True cardiac arteriovenous malformations are rare anomalies that may be acquired or congenital in origin. These anomalies are well demonstrated by Multi Detector Computed Tomography (MDCT) with much higher clarity and anatomic detail than invasive angiography. We report a case of large complex cardiac vascular malformation in 55 year old male involving feeders from systemic (internal mammary artery, right inferior phrenic artery), coronary (left anterior descending), and pulmonary arterial and venous systems using a 64 slice MDCT scanner. Cardiac AV malformations have previously been described using MDCT, but this case is unique in terms of its large size, extensive involvement of systemic, coronary and pulmonary vascular connections, and mild clinical symptomatology. Our case shows that patients with complex coronary malformation may not always require treatment as natures’ pathways may work well throughout lifetime.