Objective To analyze the characteristic features of bilateral coronary artery to pulmonary fistula (Bi-CAPF) by coronary computed tomography angiography (CCTA). Methods 20 cases of Bi-CAPF were detected by CCTA. We retrospectively analyzed the anatomical characteristics, including number of origins, course, opening site and size of the fistula, and presence of aneurysmal changes. Results All the 20 cases arose from the conus branch of the right coronary and proximal left anterior descending. All Bi-CAPF coursed anteriorly to the main pulmonary artery and drained into the left anterolateral aspect. 13 cases (65%) were present with aneurysmal changes. The median size of the opening site was 3.5mm (arranged from 0.9mm to 7.5mm). The difference of the diameter of the opening site between the group with aneurysmal changes and the group without aneurysmal changes was significant (P=0.018). The difference of the diameter of the proximal of LAD between the two groups was also significant (P=0.046). The difference of the diameter of the conus branch of the RCA was not significant (P=0.291). Conclusion CCTA can clearly visualize the morphological features of the Bi-CAPF, It can be used to provide comprehensive information for determining operative strategies.