Anomalous LAD - septal/subpulmonic course
Citation, DOI & case data
Chest pain for investigation
Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
Loading Stack -
0 images remaining
The LAD (white arrowhead) is seen to arise from the right coronary artery, and passes within the septum before reaching the interventricular groove. The circumflex (black arrowhead) arises directly from the left coronary sinus.
On sagittals, the LAD course is seen to pass below the right ventricular outflow tract ie subpulmonic course.
An anomalous coronary artery arising from the opposite sinus usually takes four common courses:
- septal (subpulmonic)
In the case above, the course of the LAD is septal (subpulmonic). This can be difficult to differentiate from a malignant interarterial course, but a septal LAD has a more inferior position. Also a septal LAD is usually surrounded by myocardium compared to the interarterial course where it is surrounded by epicardial fat. A septal LAD also has a downwards course giving the 'hammock sign', and usually does not have an oblong or slit-like orifice, unlike the inter-arterial variant.
- 1. Pursnani A, Jacobs JE, Saremi F et-al. Coronary CTA assessment of coronary anomalies. J Cardiovasc Comput Tomogr. 6 (1): 48-59. doi:10.1016/j.jcct.2011.06.009 - Pubmed citation
- 2. Kim SY, Seo JB, Do KH et-al. Coronary artery anomalies: classification and ECG-gated multi-detector row CT findings with angiographic correlation. Radiographics. 26 (2): 317-33. doi:10.1148/rg.262055068 - Pubmed citation
3 articles feature images from this case
10 public playlists include this case
- Cardiac 3 - Myo/Pericardium & CAD by Sean Gillen ◉
- Viva 2022 Cardiac by Kenneth Cheung
- cardiac by abdallah abu younes
- FRCR 2B by Dylan Kurda
- CardiacImaging by Payam Riahi
- Herz-CT by Al-Manari
- Vascular & Intervention by Matt Page
- Chest CT anatomical variants by Henry Knipe ◉ ◈
- cardiac by Rokia Hesham Abd elrahman
- AAM 2 by Avni K P Skandhan ◉