We report a rare case of a 68-year-old man with thymoma and coronary–pulmonary artery fistulas. The thymoma was 66 × 51 × 88 mm in size and accompanied by a feeding vessel originating from the coronary–pulmonary artery fistulas. We performed total thymectomy and resection of coronary–pulmonary artery fistulas at the same time, which has not been reported in the literature. The fistulas along with the left main trunk were successfully resected while temporarily transecting the main pulmonary artery. This strategy was a useful option for obtaining a good field of vision around the left main trunk behind the main pulmonary artery.
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