CTICasesAnomalous Right Coronary Artery from the Left Coronary Cusp with Intramural Course
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Imaging findings
Coronary CT angiography reveals an anomalous origin of the right coronary artery (RCA) from the left coronary cusp. The proximal vessel demonstrates a very acute takeoff angle and severe compression as it courses intramurally within the aortic wall before regaining a normal caliber.
Key takeaways
An anomalous right coronary artery with an intramural course carries a risk of myocardial ischemia and sudden cardiac death, particularly during exercise. Surgical unroofing of the intramural segment is the preferred treatment to relieve the compression.
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