Image of the Month - May 2016 - Coronary artery anomalies, benign or malignant course? Dr Michelle Williams

by Dr Michelle Williams, University of Edinburgh

Coronary artery anomalies of origin or course are occasionally identified as incidental findings on CT coronary angiography. These two images are from different patients. Figure A has an anomalous right coronary artery arising from the left coronary cusp and passing between the aorta and main pulmonary artery (arrow). Figure B has an anomalous left circumflex artery arising from the right coronary cusp and passing behind the the aorta. 


Which if these images demonstrate an anomalous coronary artery course which is referred to as a benign course, and which is a malignant course?

2016 may anomalous



An anomalous coronary artery passing between the aorta and the main pulmonary artery (an inter arterial course) is referred to as a malignant course (Figure A). Due to the high pressure nature of both of these structures there is potential for this anomalous coronary artery to be compressed. These may require further investigation or treatment. Figure B demonstrates a benign course (a retroaortic course) which requires no further assessment. 


Kim SY, et al. Coronary artery anomalies: classification and ECG-gated multi-detector row CT findings with angiographic correlation. Radiographics 2006: 26 (2)