CTICasesAnomalous Right Coronary Artery from the Pulmonary Artery
Imaging findings
Coronary CTA in a 60-year-old female shows a massively dilated, tortuous right coronary artery (RCA), as well as dilated left anterior descending (LAD) and circumflex arteries. The origin of the RCA arises abnormally from the pulmonary trunk rather than the right sinus of Valsalva. Extensive, tortuous collateral vessels are present connecting the left coronary system to the RCA territory.
Key takeaways
Anomalous right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly. Unlike ALCAPA (which usually presents in infancy and is fatal), ARCAPA is often asymptomatic until adulthood because the right ventricle has lower oxygen demands and retrogradely fills via left-to-right collaterals. Over time, it causes chronic coronary steal and myocardial ischemia.
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