CT
Coronary arteries:
Right dominant coronary system.
Anomalous left coronary artery arising from the right coronary cusp, passing between the aorta and pulmonary artery with a short intramural course. SA nodal branch arises from the left circumflex.
LMS: Mild calcified plaque distally, less than 25% stenosis.
LAD: Mild calcified plaque in the proximal vessel, less than 25% stenosis. Mild mixed plaque in the mid vessel, <50% stenosis. Otherwise normal vessel.
LCX: Minor calcified plaque in the proximal vessel, less than 10% stenosis. Mild calcified plaque in OM3, less than 25% stenosis. Otherwise normal.
RCA: Large plaque with high-risk plaque features in the proximal vessel (positive remodelling, low attenuation plaque, napkin ring sign), 50-70% stenosis. Otherwise normal.
Cardiac findings:
Mild aortic valve and mitral valve calcification. Otherwise normal cardiac valves and chambers.
Mildly enlarged ascending aorta - up to 45 mm. The sinus of Valsalva measures 41 mm in diameter.
Conclusion:
Anomalous origin of the left coronary artery with the inter-arterial course.
Nonobstructive coronary artery disease with high-risk plaque in the proximal right coronary artery.