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Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery in Adulthood on CT and MRI

Arati Khanna1, Drew A. Torigian2, Victor A. Ferrari3, Robert J. Bross4 and Mark A. Rosen2

1 Department of Radiology, Drexel University College of Medicine, Philadelphia, PA 19102.
2 Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104-4283.
3 Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19102.
4 Department of Family Practice, Virtua Memorial Hospital of Burlington County, Mt. Holly, NJ 08060.



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  		Fig. 1A —74-year-old woman with cough and chronic intermittent nonexertional chest discomfort atypical for angina. Axial enhanced CT shows dilated left main coronary artery (LMCA) (black arrow) originating from posterior main pulmonary artery (P) leading to dilated and tortuous left anterior descending (LAD) artery (white arrow).

 


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  		Fig. 1B —74-year-old woman with cough and chronic intermittent nonexertional chest discomfort atypical for angina. Axial enhanced CT at level of aortic root shows enlarged tortuous right coronary artery (RCA) and intercoronary collateral arteries (arrows) along epicardial surface of heart.

 


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  		Fig. 1C —74-year-old woman with cough and chronic intermittent nonexertional chest discomfort atypical for angina. Confirmatory cardiac MRI shows anomalous origin of left coronary artery from pulmonary artery (ALCAPA). Axial thin-section and oblique coronal maximal-intensity-projection (MIP) postgadolinium fat-suppressed T1-weighted gradient-echo images (TR/TE, 150/1.6/flip angle [FA] 90° and TR/TE, 3.8/0.9/FA 20°, respectively) show dilated LMCA (black arrow, C) originating anomalously from posterior main P, leading to dilated and tortuous LAD (arrows).

 


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  		Fig. 1D —74-year-old woman with cough and chronic intermittent nonexertional chest discomfort atypical for angina. Confirmatory cardiac MRI shows anomalous origin of left coronary artery from pulmonary artery (ALCAPA). Axial thin-section and oblique coronal maximal-intensity-projection (MIP) postgadolinium fat-suppressed T1-weighted gradient-echo images (TR/TE, 150/1.6/flip angle [FA] 90° and TR/TE, 3.8/0.9/FA 20°, respectively) show dilated LMCA (black arrow, C) originating anomalously from posterior main P, leading to dilated and tortuous LAD (arrows).

 


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  		Fig. 1E —74-year-old woman with cough and chronic intermittent nonexertional chest discomfort atypical for angina. Oblique sagittal postgadolinium fat-suppressed T1-weighted gradient-echo MIP images (TR/TE, 3.8/0.9/FA 20°) during early and late phases of enhancement reveal early lack of enhancement of ALCAPA (arrows) during enhancement of P with subsequent late enhancement of ALCAPA, implying retrograde flow of blood within ALCAPA from RCA.

 


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  		Fig. 1F —74-year-old woman with cough and chronic intermittent nonexertional chest discomfort atypical for angina. Oblique sagittal postgadolinium fat-suppressed T1-weighted gradient-echo MIP images (TR/TE, 3.8/0.9/FA 20°) during early and late phases of enhancement reveal early lack of enhancement of ALCAPA (arrows) during enhancement of P with subsequent late enhancement of ALCAPA, implying retrograde flow of blood within ALCAPA from RCA.

 


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  		Fig. 1G —74-year-old woman with cough and chronic intermittent nonexertional chest discomfort atypical for angina. Oblique coronal postgadolinium fat-suppressed T1-weighted gradient-echo MIP image (TR/TE, 3.8/0.9/FA 20°) shows orthotopic dilated and tortuous RCA (arrow).

 


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  		Fig. 1H —74-year-old woman with cough and chronic intermittent nonexertional chest discomfort atypical for angina. Axial T1-weighted cine gradient-echo image (TR/TE, 36/3.3/FA 30°) through ventricles shows high-signal-intensity flow in enlarged intercoronary collateral arteries (arrow).

 

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