A 26-year-old man presented with inferior wall myocardial infarction (MI). Primary percutaneous Coronary angiography was performed using the right femoral approach. The left system showed a patent left main coronary artery trifurcating into the left anterior descending, left circumflex, and ramus intermedius branches. All these arteries were normal. Collaterals were identified from the left system to the right coronary artery. After several unsuccessful attempts to cannulate the right coronary artery, a nonselective injection into the aortic root revealed its ostium at the left coronary cusp. Subsequent opacification of the right coronary artery using amplatz left 1 catheter showed a large aneurysmal dilatation of the proximal part with huge thrombus causing limitation of flow. An abnormal track was also present leading from the RCA to one of the cardiac chambers. It was suspected to be obstructed by the thrombus (Image A, Videos 1, 2 ). The patient was transferred to the coronary care unit. Intravenous anticoagulation was added to his treatment. Computed tomography coronary angiography was done on the following day showed abnormal origin of the right coronary artery with thrombosed fistula between the right coronary artery and right atrium (Image D, E). Post MI echocardiography showed no normal left ventricular dimensions with wall motion abnormality in the inferior wall parasternal short axis at the level of great vessels showed the aneurysm of the proximal RCA but no evidence of abnormal flow to any cardiac chamber (Image B, C Videos 3, 4 ) ( Fig. 1 ).