A case of an anomalous left coronary artery from the right coronary sinus with prepulmonic course with both the right coronary artery and left main originating from the right coronary sinus with separate adjacent openings. There is right coronary arterial dominance. The left main artery takes its path in front of the right ventricular outflow tract. This anatomical variation is considered harmless.

Anomalous coronary arteries can have both benign and malignant courses. the vessels running between the aorta and the pulmonary artery usually have a malignant course, but those running in front of the pulmonary artery (pre-pulmonic course) as in our case, or behind the aorta (retro-aortic course ) are considered benign.

Case courtesy of Dr. Safwat Almoghazi MD, Radiologist, and Dr. Ahmad Nabil MD, Cardiologist