PMC9256456_01
Right coronary angiogram (left anterior oblique 30 /cranial 30 ) revealing a small anomalous LAD artery (blue arrows), a large ectatic RCA giving rise to the LCx (white arrows), multiple RCA lesions (green arrows) with an 80-90% mid to distal calcified eccentric lesion (green arrow with asterixis), a filling defect representing a thrombotic occlusion in the distal RCA (red arrow), and a 70% mid right posterior descending artery concentric lesion (yellow arrow).
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fig1
The first was originating posteriorly from the right cusp (Figure 1, blue arrows) and the second (Figure 2, blue arrows) was originating from the anomalous left circumflex artery (Figures 1 and 2, white arrows). Additionally, he had an extremely ectatic large caliber right coronary artery (RCA) with multiple lesions (Figure 1, green arrows). The most significant was a 80-90% mid to distal calcified eccentric lesion (Figure 1, green arrow with asterixis). There was also evidence of a filling defect representing a thrombotic occlusion in the distal RCA (Figure 1, red arrow), and this gives rise to the anomalous left circumflex artery (LCX) (Figures 1 and 2, white arrows).
Right coronary angiogram (left anterior oblique 30 /cranial 30 ) revealing an anomalous LCx artery (white arrows), the second small LAD artery (blue arrows), 1st and second diagonal arteries (yellow arrows), and 1st and second obtuse marginal arteries (blue arrows).
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fig2
The first was originating posteriorly from the right cusp (Figure 1, blue arrows) and the second (Figure 2, blue arrows) was originating from the anomalous left circumflex artery (Figures 1 and 2, white arrows). There was also evidence of a filling defect representing a thrombotic occlusion in the distal RCA (Figure 1, red arrow), and this gives rise to the anomalous left circumflex artery (LCX) (Figures 1 and 2, white arrows).
Coronary CT showed the absence of a left coronary system (blue arrow), a large calcified RCA originating posteriorly from the right coronary cusp (yellow arrow), and a small LAD artery originating from the right coronary cusp into the interventricular groove (red arrows).
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fig3
CT coronary showing a large calcified RCA originating posteriorly from the right coronary cusp (green arrow) and a small LAD artery originating from the right coronary cusp into the interventricular groove (green arrow with asterixis).
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