Coronary Artery Anomalies: a Pictorial Review

Coronary artery anomalies range in prevalence from 0.2 to 2.3 % of the population. They range from benign incidental findings to an important cause of sudden cardiac death (SCD). In fact, coronary anomalies are the second leading cause of SCD in athletes and are responsible for ∼30 % of SCD in the young. Clinically, anomalous coronary arteries arising from the opposite sinus and anomalous left coronary artery arising from the pulmonary artery are the most important as they are associated with the highest risk of mortality. Several high-risk features and their pathophysiology are reviewed. Multiple imaging modalities have been utilized to study coronary artery anomalies; however, coronary computed tomography angiography (CTA) is uniquely suited to characterize coronary artery anomalies as it allows for clear elucidation of origin, course, and termination in relationship to other relevant anatomy with high spatial resolution. This paper will provide an overview of the wide spectrum of coronary artery anomalies and variants, review the most relevant coronary CTA imaging features for each, and differentiate benign from malignant varieties.