Malignant inter-arterial course of right coronary artery (RCA)
Chest pain. Positive stress test. Conventional coronary angiography depicts severe stenosis at the proximal aspect of the LAD and could not visualize RCA ostium.
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CT demonstrates a malignant inter-arterial course of RCA which arises from the anterior aspect of the left sinus of Valsalva and passing to the right between ascending aorta and pulmonary trunk.
There is also significant pre-occlusive thrombotic stenosis at the proximal short segment of the LAD.
This case is interesting because the patient was older and has a significant stenosis of LAD, which probably caused the chest pain and the malignant coronary anomaly found incidentally.