CTICasesAnomalous Origin of Right Coronary Artery from Septal Perforator
Imaging findings
CT coronary angiography shows a congenital absence of the right coronary artery (RCA) ostium at the right coronary cusp. Instead, a small RCA arises directly from the first septal perforator branch of the LAD, with normal biventricular function and no evidence of myocardial infarction.
Key takeaways
An anomalous origin of the RCA from a septal perforator of the LAD is an extremely rare congenital coronary anomaly. It is usually benign and discovered incidentally, as the left coronary system hypertrophies to supply the entire myocardium. It must be distinguished from chronic total occlusion of the RCA, which typically shows a residual ostial stump.
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