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Malignant right coronary artery anomaly identified by multidetector computed tomography and stress myocardial single photon emission computed tomography.

Anomalous origin of the right coronary artery from the left sinus of Valsalva with subsequent coursing between the aorta and pulmonary trunk is a relatively uncommon congenital defect, with a reported incidence of less than 1% in patients undergoing coronary angiography. It is well established that this anomaly can cause angina pectoris, myocardial infarction, or sudden cardiac death in the absence of atherosclerosis. The identification of this disease anomaly, however, can be difficult with conventional x-ray angiography because of the lack of 3-dimensional information that relates the spatial orientation of the anomalous coronary artery to the great vessels. Compared with invasive angiography, multidetector computed tomography allows a more accurate depiction of the origin and course of the anomalous coronary artery. In combination with stress myocardial perfusion, multidetector computed tomography can provide an accurate diagnosis and a complete anatomic and functional assessment of this potentially lethal anomaly to guide patient management. In this article, we present a young female patient with an acute inferior myocardial infarction whose multidetector computed tomography angiography and dipyridamole Tl-201 myocardial single photon emission computed tomography were shown to play a complementary role in the full evaluation of such a malignant coronary anomaly.