CTICasesAnomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) with Intramural Aortic Course
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Imaging findings
CT showed the left main coronary artery appearing to arise from both the pulmonary artery and the left coronary cusp. Angiography demonstrated an anomalous origin of the left main coronary artery from the main pulmonary artery, with extensive collateralization from the right coronary artery supplying the left system and retrograde flow into the pulmonary artery. The unusual appearance on CT was due to a rare intramural course within the wall of the aorta.
Key takeaways
ALCAPA is a rare congenital anomaly where the left main coronary artery arises from the pulmonary artery. The clinical presentation varies depending on the degree of collateralization from the right coronary artery; poor collateralization leads to myocardial infarction early in life, while good collateralization allows survival into adulthood or older childhood. This case represents a very rare variant of ALCAPA where the anomalous left main coronary artery has an intramural course within the aortic wall, making diagnosis challenging.
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