Presentation
Asymptomatic.
Patient Data
A diminutive right coronary artery (RCA) originates from anomalous high location at the sinotubular junction, instead of the expected more inferior location at mid (aortic) sinus. There is also clockwise radial malpositioning, as the artery origin is directly superior to the right coronary/left coronary commissure.
Of note, there is short segment increased acute angulation at the most proximal segment of RCA, just beyond the origin (best appreciable on maximum intensity projection image). The vessel has a narrowed appearance near the ostia. These findings are suggestive of an interarterial course.
A dominant left coronary artery (LCA) originates from the expected location at left coronary cusp.
Volumetric CT reconstruction better showing the relationship of the anomalous RCA and dominant normally-originating LCA.
Case Discussion
This case illustrates the utility of ECG-gated coronary artery CT angiography for delineating anomalous coronary artery anatomy. This case is an example of both anomalous location of the right coronary ostium, as well as anomalous course of the right coronary artery.
When reporting abnormal coronary arterial origin and course, it is important to identify findings which are considered "malignant", such as an interarterial course. Although the ultimate decision on whether to address any lesion depends on the hemodynamic significance and clinical context, these findings should be highlighted due to an associated with sudden cardiac death.
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