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An unusual coexistence presenting with retroaortic anomalous coronary sign: left main coronary artery from the non-coronary sinus and accessory circumflex artery from the right coronary sinus.

A 36-year-old male patient, with a history of atrioventricular nodal reentry tachycardia ablation and hypothyroidism, was admitted to the cardiology clinic with palpitations. Transthoracic echocardiogram of apical four-chamber view showed retroaortic anomalous coronary (RAC) sign (Fig. 1a) [1] which represents a retroaortic anomalous coronary artery. Coronary computed tomography angiography (CTA) revealed an accessory circumflex artery (CX) arising from the right coronary sinus (Fig. 1b) and passes in a retro-aortic location and this anomaly causes the RAC sign (Fig. 1c). In addition to accessory CX, CTA showed the normal CX coming off the LMCA (Fig. 1d) and anomalous origin of the left main coronary artery (LMCA) from the non-coronary sinus of valsalva (Fig. 1e and f).