Anomalous right coronary artery (ARCA) with interarterial course
40-year old woman with atypical chest pain and normal stress test.
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C+ arterial phase
Cardiac CT, axialThis transverse slice through the ascending aorta shows an anomalous origin of the left carotid artery (LMS), which is located posteriorly on the ascending aorta right above the left sinus of Valsalva. The aorta seems to be "twisted" clockwise with 90 degrees. Distally the LMS can be seen to be bifurcating into the LAD (located medially) and the circumflex artery (Cx).
This patient has an anomalous right coronary artery (ARCA) originating from the anterior side of the ascending aorta and coursing between the pulmonary trunc and ascending aorta (= interarterial course).
An ARCA with interarterial course has a severe prognosis and is therefore referred to as malignant.
Symptomatology is thought to be caused by the rising pressure within both the aorta and pulmonary artery during exercise, thereby compressing the anomalous coronary artery by a scissor-like mechanism.