case_images: PMC9256456_01
case_images: 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).
case_images: CRIC2022-7125401.001.jpg
case_images: PMC9256456_01_CRIC2022-7125401.001.jpg
case_images: fig1
case_images: 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).
case_images: 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).
case_images: CRIC2022-7125401.002.jpg
case_images: PMC9256456_01_CRIC2022-7125401.002.jpg
case_images: fig2
case_images: 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).
case_images: 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).
case_images: CRIC2022-7125401.003.jpg
case_images: PMC9256456_01_CRIC2022-7125401.003.jpg
case_images: fig3
case_images: 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).
case_images: CRIC2022-7125401.004.jpg
case_images: PMC9256456_01_CRIC2022-7125401.004.jpg
case_images: fig4