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Fig. 4 | Insights into Imaging

Fig. 4

From: Chest CT examinations in patients presenting with acute chest pain: a pictorial review

Fig. 4

A 73-year male patient presented with acute chest pain. His history revealed extensive coronary artery disease diagnosed as invasive angiography because of angina, although it was impossible to selectively image the right coronary artery (RCA), possibly because of an anomalous origin. Conventional angiography was repeated in our hospital, to visualize the aberrant RCA. During the procedure, patient had asystoly and resuscitation. Emergency coronary CTA was performed, after which the patient underwent emergency bypass surgery. (a,b) Coronary CTA in oblique transverse view of the aortic root. Aberrant RCA running between the aorta (Ao) and pulmonary artery (PA, malignant variant), arrow in a and b. The RCA was of poor quality with multiple stenosis (arrow in b). Note the narrow origin and proximal part of the RCA arising near the left coronary cusp at approximately 2 o’clock with a sharp angle with the aorta (normal origin is at right coronary cusp at approximately 11 o’clock, arising with perpendicular orientation from the aorta). Significant three-vessel disease was present. The patient underwent emergency bypass surgery. LA, left atrium

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