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26 Y/O Male with Chest Pain

Slides 1-2:  CTPE for r/o PE.  Highly suggestive of “malignant” or Interarterial anomalous origin of RCA.

Slides 3-5:  CCTA confirms anomalous origin RCA.  Crosses between Aorta and PA.  Mass effect on the RCA as it passes between vessels can cause chest pain and sudden death.

Slides 6-7:  Pt had coronary artery bypass surgery to correct.

  • Anomalous origin coronary artery is an important thing to look for on PE studies particularly on younger patients with chest pain. 
  • Majority of PE studies have too much motion artifact to evaluate coronary artery course.  So most often you can’t comment.  Be careful of artifact as it can simulate anomalous origin.

Slide 8:        Note artifact in front of aortic root simulating interarterial course of right coronary artery (RCA) (arrow).  Another motion artifact can be seen behind aortic root.  DA = descending aorta; LA = left atrium; PA = pulmonary artery.