case_images: PMC3935266_01
case_images: 82-year-old man with positive ECG test but no symptoms diagnosed with an association of a malignant coronary artery anomaly of origin and course and a long myocardial bridging over the obtuse marginal branch. a) 12-lead electrocardiogram stress-test shows the 2 mm horizontal ST depression on leads V4 to V6, in absence of symptoms, during exercise. b) Multislice computed tomography (MSCT) with 3D volume rendering reconstruction reveals the abnormal origin of the left anterior descending (LAD) artery from the right sinus of valsalva (arrow). c) MSCT maximum intensity projection (MIP) reconstruction demonstrates the anomalous course of LAD artery (arrowheads) running between the aorta and the right ventricular outflow tract (malignant variant). d) MSCT MIP reconstruction illustrates the intramural course ("myocardial bridging") of the obtuse marginal branch (arrowheads) within the left ventricular lateral wall. Ao: Ascending aorta, RVOT: Right ventricular outflow tract, LV: Left ventricle, RSV: Right sinus of valsalva, LA: Left atrium, RA: Right atrium, LSV: Left sinus of valsalva, LV: Left ventricle.
case_images: JCIS-3-68-g002.jpg
case_images: PMC3935266_01_JCIS-3-68-g002.jpg
case_images: F1
case_images: Due to the diagnosis of familial hypercholesterolemia, he underwent a screening ECG stress test that showed a 2 mm horizontal ST depression on leads V4 to V6 [Figure 1a], though he showed no symptoms. In order to exclude coronary artery disease, the patient underwent a 128-slice coronary-computed tomography (multi-slice CT [MSCT]) scan that revealed abnormal origin of the left anterior descending (LAD) artery from the right sinus of valsalva (RSV) with malignant course of the artery running between the aorta and the right ventricular outflow tract [Figure 1b and c]. Moreover, a long muscular bridge over the obtuse marginal branch originating from the circumflex artery was also demonstrated [Figure 1d].