Retroaortic anomalous coronary sign (echocardiography)
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The retroaortic anomalous coronary (RAC) sign describes the sonographic appearance of an anomalous left coronary artery traveling posteriorly to the aortic root. It is most commonly observed with anomalous origin of the left circumflex artery from the right sinus of Valsalva, but is also described in cases with an anomalous left main coronary artery 1.
It is visualized in a modified apical four chamber view on transthoracic echocardiography, tilting the imaging plane anteriorly. It is found in near apposition to the atrial side of the atrioventricular groove, appearing as a tubular, hyperechoic structure oriented perpendicularly to the course of the aortic root 2. It may also be viewed from apical two and long axis views, found just superior to the mitral annular plane 3.
- 1. Mancinelli A, Golino M, Miglierina E, My I, Crippa M, De Ponti R. Three Echocardiographic Signs to Identify Anomalous Origin of the Circumflex Coronary Artery from the Right Sinus of Valsalva: A Case Report. CASE (Phila). 2020;4(5):324-7. doi:10.1016/j.case.2020.07.008 - Pubmed
- 2. Massobrio L, Valbusa A, Bertero G et al. Detection of the “Crossed Aorta Sign” During Echocardiography Before Angiography. Case Reports in Cardiology. 2017;2017:1-3. doi:10.1155/2017/9249821 - Pubmed
- 3. López V & Blanco P. Retroaortic Anomalous Coronary Artery Visualization on Transthoracic Echocardiogram. J Cardiovasc Echogr. 2021;31(3):179-80. doi:10.4103/jcecho.jcecho_6_21 - Pubmed