CTICasesHigh Origin Right Coronary Artery
Imaging findings
CT angiography demonstrates a right coronary artery arising from above the sinotubular junction, superior to what would be the left cusp, with a medially oriented origin coursing inferiorly between the aorta and the pulmonary artery before taking its normal course in the atrioventricular groove. There is no true intramural or interarterial course, as the artery does not course within the wall of the aorta, and there is no acute angle takeoff indicating a malignant course.
Key takeaways
High origin of the right coronary artery above the sinotubular junction is a recognized variant that characteristically demonstrates a medially oriented proximal course. Although it courses between the aorta and pulmonary artery, this is not considered a malignant interarterial course because there is no intramural aortic segment. The medial orientation of the proximal vessel is a consistent feature of this anomaly. The finding is important to recognize in order to avoid mischaracterization as a malignant anomalous coronary.
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