A Rare Anomalous Origin of the Right Coronary Artery From Mid-Left Anterior Descending Artery

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BACKGROUND: Coronary artery anomalies represent the second leading cause of sudden cardiac death among young athletes, with limited evidence for the management of symptomatic individuals. CASE SUMMARY: We present a case of a single coronary artery anomaly; the right coronary artery (RCA) originating from the mid-left anterior descending artery (LAD). Further evaluation with stress imaging showed no evidence of stress-induced ischemia. DISCUSSION: This represents a rare case of an anomalous origin and course of the RCA from the mid-LAD with a malignant interarterial course. The initial diagnosis was an ostial RCA chronic total occlusion with presumed retrograde filling from the LAD. However, a careful review of the angiogram demonstrated antegrade rather than retrograde flow. The diagnostic uncertainty was ultimately resolved by computed tomography coronary angiography. TAKE-HOME MESSAGE: In case of suspected coronary anomalies or an unclear coronary course and/or origin, a computed tomography angiography is strongly recommended.