CTICasesAnomalous Right Coronary Artery from the Pulmonary Artery (ARCAPA) and Patent Ductus Arteriosum
Imaging findings
Chest CT demonstrates markedly dilated, tortuous coronary arteries. The right coronary artery is seen anomalously arising directly from the main pulmonary artery. Extensive, enlarged collateral vessels are visible connecting the left coronary system to the right coronary artery. Additionally, a small, patent ductus arteriosum and a tiny defect in the interatrial septum with a contrast jet are noted.
Key takeaways
Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital anomaly that is often detected incidentally in adults. The lower pressure in the pulmonary circulation results in a coronary steal phenomenon, where blood flows from the high-pressure left coronary artery, through collateral vessels, into the right coronary artery, and retrogradely into the pulmonary artery, leading to marked coronary dilation. Finding one congenital cardiovascular anomaly should always prompt a search for associated anomalies, such as a patent ductus arteriosum.
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