Retroaortic anomalous coronary sign (echocardiography)

Last revised by Dr David Carroll on 30 May 2022

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

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