Late pericardial tamponade and coronary arteriovenous fistula after trauma

A 48 year old man presented with cardiac tamponade six weeks after an apparently minor penetrating chest injury. Thoracotomy showed a haemopericardium with no actively bleeding vessel. Re-investigation eleven months later, prompted by persistent chest pain, showed the presence of a fistula between the second diagonal of the left anterior descending coronary artery and a cardiac vein.