CTICasesALCAPA in an Adult
Imaging findings
Cardiac CT of a 20-year-old male with atrial fibrillation shows anomalous origin of the left main coronary artery from the pulmonary artery (ALCAPA). The right coronary artery is massively dilated. Extensive intercoronary collaterals are present, with retrograde flow from the RCA filling the LCA and dumping into the pulmonary artery. Mid-myocardial hypokinesis and subendocardial calcification are present.
Key takeaways
ALCAPA (Bland-White-Garland syndrome) can rarely present in adulthood if robust intercoronary collaterals develop early in life. It acts as a left-to-right shunt and causes chronic myocardial ischemia, often manifesting with subendocardial calcification and hypokinesis.
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