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Anomalous Coronary Arteries in Adults: Depiction at Multi–Detector Row CT Angiography¹

¹ From the Departments of Radiology (J.D., R.C.A.) and Cardiology (S.K.), Vanderbilt University, Nashville, Tenn; Department of Diagnostic Radiology, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (C.S.W.); Department of Radiology, University Hospital, Cleveland, Ohio (R.C.G.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (C.A.M.); Meharry Medical College, Nashville, Tenn (M.L.J.); and Philips Medical Systems, Cleveland, Ohio (K.R.). Received February 17, 2004; revision requested April 23; revision received July 15; accepted August 18. Address correspondence to C.S.W. (e-mail: cwhite@umm.edu).

View larger version (142K): [in a new window]   Figure 1a. Images obtained in a 45-year-old woman with recurrent chest pain and palpitations. (a) Coronary angiogram obtained with a right anterior oblique projection shows an anomalous right coronary artery (arrow) originating from the proximal left anterior descending artery and extending to the anterior atrioventricular groove. (b, c) Transverse CT scans obtained with a four-section scanner show the anomalous right coronary artery (arrow) arising from the left anterior descending artery and coursing anterior to the main pulmonary artery (P) into the anterior atrioventricular groove. A = aorta.

View larger version (95K): [in a new window]   Figure 1b. Images obtained in a 45-year-old woman with recurrent chest pain and palpitations. (a) Coronary angiogram obtained with a right anterior oblique projection shows an anomalous right coronary artery (arrow) originating from the proximal left anterior descending artery and extending to the anterior atrioventricular groove. (b, c) Transverse CT scans obtained with a four-section scanner show the anomalous right coronary artery (arrow) arising from the left anterior descending artery and coursing anterior to the main pulmonary artery (P) into the anterior atrioventricular groove. A = aorta.

View larger version (106K): [in a new window]   Figure 1c. Images obtained in a 45-year-old woman with recurrent chest pain and palpitations. (a) Coronary angiogram obtained with a right anterior oblique projection shows an anomalous right coronary artery (arrow) originating from the proximal left anterior descending artery and extending to the anterior atrioventricular groove. (b, c) Transverse CT scans obtained with a four-section scanner show the anomalous right coronary artery (arrow) arising from the left anterior descending artery and coursing anterior to the main pulmonary artery (P) into the anterior atrioventricular groove. A = aorta.

View larger version (102K): [in a new window]   Figure 2a. Images obtained in a 48-year-old woman who underwent coronary angiography for progressive angina and was found to have a single coronary artery arising from the right cusp. A = aorta. (a) Transverse CT scans obtained with a four-section multi-detector row CT unit show the origin of the common coronary artery and the separate courses of the right (arrow) and left (arrowhead) coronary arteries. The left coronary artery crosses anterior and superior to the main pulmonary artery (P). (b, c) Two volume-rendered images obtained with oblique (left) and anterior (right) projections show the left coronary artery (white arrow) passing anterior and superior to the main pulmonary artery (P). Black arrow indicates the right coronary artery.

View larger version (109K): [in a new window]   Figure 2b. Images obtained in a 48-year-old woman who underwent coronary angiography for progressive angina and was found to have a single coronary artery arising from the right cusp. A = aorta. (a) Transverse CT scans obtained with a four-section multi-detector row CT unit show the origin of the common coronary artery and the separate courses of the right (arrow) and left (arrowhead) coronary arteries. The left coronary artery crosses anterior and superior to the main pulmonary artery (P). (b, c) Two volume-rendered images obtained with oblique (left) and anterior (right) projections show the left coronary artery (white arrow) passing anterior and superior to the main pulmonary artery (P). Black arrow indicates the right coronary artery.

View larger version (137K): [in a new window]   Figure 2c. Images obtained in a 48-year-old woman who underwent coronary angiography for progressive angina and was found to have a single coronary artery arising from the right cusp. A = aorta. (a) Transverse CT scans obtained with a four-section multi-detector row CT unit show the origin of the common coronary artery and the separate courses of the right (arrow) and left (arrowhead) coronary arteries. The left coronary artery crosses anterior and superior to the main pulmonary artery (P). (b, c) Two volume-rendered images obtained with oblique (left) and anterior (right) projections show the left coronary artery (white arrow) passing anterior and superior to the main pulmonary artery (P). Black arrow indicates the right coronary artery.

View larger version (106K): [in a new window]   Figure 3. Patient 5. Reconstructed image obtained in a 44-year-old man with chest pain. Coronary angiography showed a shared origin of the right and left coronary arteries from the anterior cusp. CT was performed to define the course of the left main artery. Thick-slab transverse reconstruction (10-mm-thick section) shows the shared anterior orifice (white arrow) and the left coronary artery (black arrow) coursing between the aorta (A) and the main pulmonary artery (P). Note the acute angulation of the left coronary artery at its origin. The patient underwent bypass grafting.

View larger version (113K): [in a new window]   Figure 4. Patient 4. Transverse CT scan obtained in a 59-year-old man with chest discomfort. Although results of coronary angiography were suggestive of an anomalous left coronary artery, the relationship to the great vessels was uncertain. Transverse image obtained with a 16-section CT unit shows the left anterior descending coronary artery (white arrow) arising from the right coronary artery (black arrow) anterior to the aorta (A). The anomalous vessel courses between the aorta and right ventricular outflow track (RV). The course of the artery is more inferior than that illustrated in Figure 3. In addition, the vessel courses through muscle, which is consistent with an intraseptal location.

View larger version (124K): [in a new window]   Figure 5a. Images obtained in a 28-year-old man with hypertension, recurrent chest pain, and an anomalous right coronary artery. (a) Coronary angiogram obtained in a left anterior oblique projection shows the anomalous right coronary artery (arrow) originating from the left coronary artery. (b, c) Contiguous transverse thick-slab reformations (10-mm-thick section) from a four-section CT unit show the right coronary artery (arrow in b) originating from the left cusp (arrowhead) and extending between the aorta (A) and the main pulmonary artery (P) to reach the anterior atrioventricular groove. (d) Volume-rendered image demonstrates the anomalous vessel (arrow) extending from the left cusp anteriorly. A = aorta, P = main pulmonary artery.

View larger version (126K): [in a new window]   Figure 5b. Images obtained in a 28-year-old man with hypertension, recurrent chest pain, and an anomalous right coronary artery. (a) Coronary angiogram obtained in a left anterior oblique projection shows the anomalous right coronary artery (arrow) originating from the left coronary artery. (b, c) Contiguous transverse thick-slab reformations (10-mm-thick section) from a four-section CT unit show the right coronary artery (arrow in b) originating from the left cusp (arrowhead) and extending between the aorta (A) and the main pulmonary artery (P) to reach the anterior atrioventricular groove. (d) Volume-rendered image demonstrates the anomalous vessel (arrow) extending from the left cusp anteriorly. A = aorta, P = main pulmonary artery.

View larger version (121K): [in a new window]   Figure 5c. Images obtained in a 28-year-old man with hypertension, recurrent chest pain, and an anomalous right coronary artery. (a) Coronary angiogram obtained in a left anterior oblique projection shows the anomalous right coronary artery (arrow) originating from the left coronary artery. (b, c) Contiguous transverse thick-slab reformations (10-mm-thick section) from a four-section CT unit show the right coronary artery (arrow in b) originating from the left cusp (arrowhead) and extending between the aorta (A) and the main pulmonary artery (P) to reach the anterior atrioventricular groove. (d) Volume-rendered image demonstrates the anomalous vessel (arrow) extending from the left cusp anteriorly. A = aorta, P = main pulmonary artery.

View larger version (111K): [in a new window]   Figure 5d. Images obtained in a 28-year-old man with hypertension, recurrent chest pain, and an anomalous right coronary artery. (a) Coronary angiogram obtained in a left anterior oblique projection shows the anomalous right coronary artery (arrow) originating from the left coronary artery. (b, c) Contiguous transverse thick-slab reformations (10-mm-thick section) from a four-section CT unit show the right coronary artery (arrow in b) originating from the left cusp (arrowhead) and extending between the aorta (A) and the main pulmonary artery (P) to reach the anterior atrioventricular groove. (d) Volume-rendered image demonstrates the anomalous vessel (arrow) extending from the left cusp anteriorly. A = aorta, P = main pulmonary artery.

View larger version (110K): [in a new window]   Figure 6a. Images obtained in a 69-year-old man with chest pain. Results of coronary angiography were suggestive of an arteriovenous fistula. (a) Volumetric image shows the markedly enlarged and tortuous left circumflex vessel (arrows) coursing along the posterior cardiac surface. (b) Parasagittal thin-slab reformatted image (5-mm-thick section) shows the junction of the left circumflex artery (CX) and the great cardiac vein (GCV). Note the more normal-appearing distal (dist) circumflex artery. prox = proximal

View larger version (148K): [in a new window]   Figure 6b. Images obtained in a 69-year-old man with chest pain. Results of coronary angiography were suggestive of an arteriovenous fistula. (a) Volumetric image shows the markedly enlarged and tortuous left circumflex vessel (arrows) coursing along the posterior cardiac surface. (b) Parasagittal thin-slab reformatted image (5-mm-thick section) shows the junction of the left circumflex artery (CX) and the great cardiac vein (GCV). Note the more normal-appearing distal (dist) circumflex artery. prox = proximal