This patient is experiencing chest pain without ST elevation and had undergone catheter coronary angiography. The left system was challenging to cannulate due to an anomalous origin from the right coronary sinus. CT coronary angiography was performed to image the anomalous origin of LMCA & LCX lesions.

The right coronary artery and left main artery both originate from the right coronary sinus with separate adjacent openings, i.e. an anomalous left coronary artery origin from the right coronary sinus. The left main coronary artery has an interarterial course between the RVOT/main pulmonary artery and the aorta. This can be associated with sudden death and myocardial ischemia in younger adults, however it can also be a benign incidental finding especially in the absence of specific anatomical and dynamic features ³. Chest pain in this individual may be due to right coronary artery stenosis or a non-cardiac cause.

Case courtesy of Dr Safwat Almoghazi, MD, radiologist, Dr Shreeram Kannan Consultant Radiologist Dr Ahmed Nabil Consultant Cardiologist.