Italy's Pietro Sighel, Chiara Betti, Arianna Fontana and Thomas Nadalini beat defending champions China and world champions Canada in a scintillating final, which saw the Italians take the lead after a small mistake from China.
The medal, Italy's tenth at the Milan-Cortina Games, was Fontana's twelfth Olympic medal, putting her fourth on the all-time individual medal list.
Canada failed to grab the lead and ended with the silver medal, while surprise package Belgium, who weren't expected to reach the final, grabbed the bronze medal ahead of China.
The Netherlands, the big favourites ahead of the tournament, saw its short track tournament get off to a bad start after star skater Xandra Velzeboer fell in the semifinals. The orange crew went on to win the B final in an Olympic record time of 2:35.537.
South Korea was eliminated in the same way after the USA's Corinne Stoddard took her Korean opponent down with her in her slide. The Korean team lodged an appeal to still qualify for the final, but it was rejected.