We report an interesting case of coronary cameral fistula with associated aneurysmal dilatation of coronary artery. The complete evaluation including anatomical relationships with surrounding vascular and non-vascular structures can be achieved with ECG gated multi-detector computed tomography (MDCT). MDCT has many advantages over echocardiography and digital subtraction catheter angiography, because of its ability to demonstrate the fistula separate from surrounding cardiovascular structures along with any aneurysm or obstruction in its course. Thus, MDCT is emerging as the initial non-invasive imaging technique for comprehensive preoperative evaluation of these rare congenital anomalies for cardiovascular surgeons to achieve better operative assessibity and outcome.