CTICasesSingle Coronary Artery System
Imaging findings
CT in a teenager with prior sternotomy shows a large left coronary artery giving a branch off the LAD that wraps around the infundibulum and continues as the right coronary artery, forming a single coronary arterial system with a benign prepulmonic course of the right coronary between the sternum and outflow tract. It is a left-dominant system with the PDA arising from the circumflex, and a small SA nodal branch is also seen.
Key takeaways
A single coronary artery with the right coronary arising from the left system is rare, and a prepulmonic (anterior) course is a benign variant, in contrast to a malignant interarterial course. Coronary anomalies are associated with congenital heart disease, consistent with this patient's prior cardiac surgery, and distinguishing benign from potentially dangerous courses is the key interpretive point.
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