Malignant right coronary artery.

A 50-year-old man was admitted to a cardiologist because of atypical chest pain over several months with thoracic pain during stress exercise. Echocardiography was within normal limits. The patient was referred for further evaluation by multidetector computed tomography (MDCT). Cardiac MDCT was performed using an ECG-gated dual-source CT (Siemens Medical Systems, Forcheim, Germany) and the postprocessing reformations included thin-slab maximum-intensity projection (thinMIP), multiplanar reconstruction (MPR) and volume rendering technique (VRT). An anomalous right coronary artery (RCA) originating from the left sinus ofValsalva was seen at thinMIP (Fig. A, B).The proximal RCA was significantly narrowed when passing between the aortic root and the pulmonary trunk (Fig. C). The origin of the left coronary artery was normal. Treatment with beta blockers was proposed (Bisoprolol 2.5 mg/day as the patient had no arterial hypertension) and the patient was recommended to avoid physical effort, no surgery being indicated.