PMC3205733_01
With conventional coronary angiography, an anomalous vessel originating from the mid-LAD was observed, coursing away for the circumflex coronary artery (white arrows in (a) and (b)). CRA indicates cranial; LAO: left anterior oblique.
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fig1
In the course of the left anterior descending artery (LAD) however, an anomalous side branch originating shortly after the first diagonal branch was depicted, which coursed away from the left circumflex coronary artery (LCX) (Figures 1(a) and  1(b)).
With coronary computed tomography, the presence of an anomalous RCA originating from the mid-LAD and coursing anterior of the aorta and the pulmonary trunk could be unambiguously illustrated. Volume rendering acquisitions (a)-(b) and multiplanar reconstructions (c) demonstrate the exact anatomical course of the anomalous vessel (black arrowheads in (a) and white arrowheads in (b) & (c)). (a) Overview of coronary vessel course in relation to the great arterial vessels aorta and pulmonary trunk; (b) coronary Tree; (c) axial maximum intensity projection. Ao indicates Aorta; LA: left atrium, RV: right ventricle, and PT: pulmonary trunk.
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fig2
Furthermore, with CT images, the absence of a right coronary ostium was confirmed and the vessel originating from the mid-LAD was identified as an anomalous RCA, which indeed coursed anterior of the aorta and the pulmonary trunk to the inferior myocardial wall (Figures 2(a)-2(c)).