Anomalous LAD - septal/subpulmonic course
Chest pain for investigation
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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