Normal and Anomalous
Anatomy of the Coronary Arteries
Smita Patel, MBBS, MRCP, FRCR
T he coronary arteries and their major branches are located
predominantly on the epicardial surface of the heart,
surrounded by epicardial fat, with the exception of the septal
perforators, which run in the ventricular septum and are
surrounded by muscle. There are two main coronary arteries,
the right and left coronary arteries, named according to their
distal myocardial vascularization territory. Refer to Figure 1
for axial anatomy of the coronary arteries.
Normal Anatomy
Right Coronary Artery
The right coronary artery (RCA) arises from the anteriorly-
positioned right sinus of Valsalva and courses anteriorly and
inferiorly in the right atrioventricular (AV) groove1-3 (Fig. 2).
The conus artery is the first branch of the RCA in 50% of
patients and supplies the right ventricular infundibulum. In
the other half of patients, the conus artery arises directly from
the aortic root. The second branch of the RCA is the SA nodal
branch (Fig. 3) in 60% of patients; in the remaining 40% of
patients, it arises from the left circumflex coronary artery
(LCX). The RCA gives off small branches that supply the atria
and the free wall of the right ventricle, with a larger branch,
the acute marginal coming off at the acute margin of the
heart.4 At the crux of the heart the RCA gives rise to the
posterior descending artery (PDA), which supplies the pos-
terior interventricular septum and the posterolateral branch
(PLB), which continues in the posterior left AV groove and
supplies the posterior and inferior wall of the left ventricle
(Fig. 4). When the LAD is small and does not reach the apex
of the heart, the PDA may extend to the apex of the heart and
Division of Cardiothoracic Radiology, Department of Radiology, University
of Michigan Health System, Ann Arbor, Michigan.
This work was funded in part by a RSNA Research Scholar Grant.
Address reprint requests to: Smita Patel, MBBS, MRCP, FRCR, Department
of Radiology, University of Michigan Health System, Cardiovascular
Center-Room 5338, 1500 East Medical Center Drive, Ann Arbor, MI
48109-5868. E-mail: smitap@med.umich.edu
100 0037-198X/08/$-see front matter 2008 Elsevier Inc. All rights reserved.
doi:10.1053/j.ro.2008.01.005
supply the distal third of the anterior interventricular sep-
tum. The RCA gives rise to an AV nodal branch, a vertical
branch arising just distal to the PDA origin. The distal left
circumflex may occasionally give rise to the AV nodal
branch.
Left Main Artery
The left main (LM) coronary artery arises from the posteriorly
positioned left sinus of Valsalva and divides into two major
branches, the left anterior descending coronary artery (LAD)
and the LCX1-3 (Fig. 5). The LM varies in length from 0.5 to 2
cm and is uniform in caliber. The LM can trifurcate into and
LAD, LCX, and a branch between these two, known as the
ramus intermedius (RI) (Fig. 6), which supplies the vascular
territory of the diagonal and/or obtuse marginal.
Left Anterior Descending Coronary Artery
The LAD runs anteriorly and inferiorly in the anterior inter-
ventricular groove to the apex of the heart and curves around
the apex to supply part of the inferior wall of the LV. The LAD
gives rise to two groups of vessels, the diagonals that course
along and supply the anterior wall of the LV, and septal
perforators that arise at right angles to the LAD, are of smaller
caliber than the diagonals and supply the anterior two-thirds
of the interventricular septum. The diagonals can vary in size
and number (Fig. 7A) and are sequentially numbered as they
arise from the LAD.
The LCX is a smaller vessel than the LAD. It courses in
the posterior AV groove and gives rise to obtuse marginals
(OM) arteries that are also numbered sequentially as they
arise from the LCX4 (Fig. 7B). In a left-dominant system,
the LCX continues in the posterior left AV groove and
gives rise to the PLB; at the crux of the heart it gives rise to
the PDA (Fig. 8).
Dominance
The artery that supplies the inferior portion of the posterior
interventricular septum is considered to be the dominant
artery. In 85% of patients the RCA is dominant, with the PDA
supplying the inferior septum (Fig. 4). In 7 to 8% of patients
the left coronary artery is dominant (Fig. 8), and 7 to 8% of
Figure 1 Normal axial anatomy on 64-slice CT coronary angiography at 0.625-mm collimation. AIVS anterior
interventricular septum; Ao aortic root; AV atrioventricular; Diag diagonal; LA left ventricle; LV left
ventricle; LAD left anterior descending; LM left main; LCX left circumflex; OM obtuse marginal; PDA
posterior descending coronary artery; PLB posterolateral branch; RA right atrium; RV right ventricle; RCA
right coronary artery. (A) LM arising from the left sinus of Valsalva and giving rise to the LAD and LCX. (B) LAD and
LCX, a couple of centimeters from the bifurcation of the LM. The LAD runs in the AIVS alongside the anterior
interventricular vein. (C) RCA arising a little caudally from the anterior right sinus of Valsalva. Note the LAD giving rise
to the diagonal. The LCX is just about to enter the posterior atrioventricular groove. (D). RCA in the anterior AV groove,
the OM along the lateral margin of the heart, and the distal LAD in the AIVS. (E) The mid RCA at the acute margin of
the heart, the PLB, a branch of the distal RCA crosses the crux of the heart and runs in the left posterior AV groove.
(F) The horizontal portion of the distal RCA is seen in the posterior right AV groove. The PDA came off the RCA and
is running in the posterior interventricular septum alongside the middle cardiac vein.
102 S. Patel

Figure 2 Normal RCA at selective coronary catheterization (A) on curved reformat (B) volume-rendered (C) and 3-D VR
coronary tree image 64-slice CT (D). (Color version of figure is available online.)
Anatomy of the coronary arteries 103

Figure 5 Axial MIP demonstrating the LM bifurcating into the LAD

and LCX. Note a high OM arising from the LCX.

Figure 3 Vessel origins: Axial oblique CT MIP demonstrating the

origins of the LM and RCA from their respective sinuses. Note parallel in the posterior interventricular groove, or the RCA
sinoatrial nodal artery arising from the RCA (arrowhead). gives rise to a small PDA and the LCX gives rise to all the
posterolateral branches. The LCX may also give rise to a PDA
patients have a codominant system or balanced circulation that supplies the distal septum.
where the RCA gives rise to the PDA and terminates in the
posterior interventricular groove. Variations include when an
LCX also gives rise to a PDA, with two PDAs running in

Figure 6 3D volume-rendered CT demonstrating the LM trifurca-

Figure 4 3D volume-rendered CT demonstrating the PDA and PLB tion. Note a large ramus intermedius arising between the LCX and
branches arising from the RCAa right dominant system. (Color LAD, supplying a large portion of the myocardium. (Color version
version of figure is available online.) of figure is available online.)
104 S. Patel

Figure 7 LAD and LCX: (A) Selective injection of the left coronary at cardiac catheterization demonstrates the LAD and
LCX and their branches. (B) Curved reformat of the LAD which courses down to the apex of the heart. (C) Oblique MIP
of the LAD and its branches, the septal perforators and the diagonals. (D) Curved reformat of the LCX as it courses in
the posterior AV and gives rise to a large OM. (E) 3-D VR image demonstrates the epicardial surface anatomy of the LAD
and LCX as they arise from the LM bifurcation. The LAD runs in the anterior interventricular groove and gives of
diagonal branches, the LCX runs in the posterior AV groove and gives rise to a large OM. (F) 3-D VR coronary tree image
of the LM, LAD, LCX and their branches. (Color version of figure is available online.)

Segmental Anatomy
For segmental anatomy of the coronary arteries different no-
menclatures developed and modified by the American Heart
Association can be used.5,6 Although the numbering of the
segments is commonly used for research purposes, these no-
menclatures are referred to when analyzing and reporting
coronary CT examinations. The RCA, LAD, and LCX coro-
nary arteries are divided into the proximal, mid, and distal
segments as follows:
RCA: proximal segment from the ostium to the acute mar-
ginal, mid segment is the one that curves around the
acute margin of the heart and the distal segment runs
along the posterior right AV groove.
LAD: proximal segment from the origin of the LAD to
either the first septal perforator or the first diagonal; the
mid segment from that point to the second diagonal and
the distal segment is from that point distally.
LCX: proximal segment is from the origin to the first ob-
tuse marginal, and the distal segment is distal to that
point.
Coronary Artery Anomalies
Anomalies of the coronary arteries are rare, occurring in 1.3%
(range 0.3-5.64%) of the population.7 They are often an
incidental finding in asymptomatic patients. Approximately
20% of coronary anomalies may have a life-threatening pre-
sentation, including myocardial infarction, arrhythmia, or
Anatomy of the coronary arteries 105

sudden death.8 Anomalous coronary arteries are most com-

monly a sporadic anomaly but may also be associated with
congenital heart disease or bicuspid aortic valve.9,10 While
the majority of coronary anomalies do not have an adverse
clinical outcome, origin of the left main, RCA, or LAD from
the opposite coronary sinus or coronary artery, with an in-
terarterial course between the aortic root and right ventricu-
lar outflow tract/pulmonary artery (Fig. 9), is most likely to
be associated with an adverse outcome, including death. In
young athletes or in young military recruits, up to a third of
cardiac-related deaths in that age group are related to such an
anomaly.11 An interarterial course is considered malignant,
as the anomalous coronary artery may be compressed be-
tween the aorta and the pulmonary artery, resulting in com-
promised blood flow to the myocardium, and is therefore
usually an indication for surgical repair, which in adults is
usually coronary artery bypass surgery. While a retroaortic
(Fig. 10) or a prepulmonic course (Fig. 11) of a coronary
anomaly is considered benign or nonmalignant, it is im-
portant to recognize the retroaortic course in patients with
aortic valve disease as this artery may be inadvertently com- Figure 9 Interarterial malignant course: Axial oblique 5-mm MIP
pressed during aortic valve or aortic root surgery. demonstrating the LM arising from the opposite right coronary si-
For many years the diagnosis of coronary anomalies re- nus and taking an interarterial course between the RVOT and the
quired catheter coronary angiography or was identified post aortic root (Ao).
mortem in fatal cases. However, the course of anomalous
coronary arteries is usually difficult to determine at catheter
structure, is seen on a two-dimensional view at catheter an-
angiography, which is obtained in a limited number of pro-
giography; hence, other imaging modalities such as magnetic
jections. The coronary artery, a complex three-dimensional
resonance imaging (MRI), transesophageal echocardiogra-
phy (TEE), or computed tomography (CT) are used to deter-
mine the proximal course. Given that MR has lower spatial
resolution and is not widely available and TEE is invasive, CT
is now the test of choice for identifying and defining the
course of anomalous coronary arteries.12 When evaluating
anomalous coronaries, it is important to determine not only

Figure 8 3D volume-rendered CT demonstrating the PDA and PLB Figure 10 Retroaortic course: Axial oblique MIP demonstrating the
branches arising from the LCXa left dominant system. Note a LM arising from the right sinus of Valsalva and taking a retroaortic
large OM arising from the LCX. (Color version of figure is available course between the aortic root (Ao) and the left atrium (LA). Note
online.) the RCA has stents.
106 S. Patel

The ostium of the involved artery may be narrow,

b. Transeptal (Fig. 13)Usually a LM or LAD runs
c. Retroaorticthe anomalous artery courses posteri-
Figure 11 Prepulmonic course. 3D volume-rendered CT demon-
strating the LAD arising from the right sinus of Valsalva (RSV) and
coursing anterior to the pulmonary artery outflow tract to reach the
AIVS. The RCA has a normal origin from the RSV and normal course
in the right atrioventricular groove. (Color version of figure is avail-
able online.)
compromising flow. Origin of the LM or LAD from
the RCA or right sinus of Valsalva, or the RCA from
the LM or left sinus of Valsalva (LSV), taking an
interarterial course is considered potentially fatal
and often requires surgical intervention. This entity
is associated with poor prognosis particularly in
young athletes or military recruits.19
anteriorly and inferiorly into the septum (subpul-
monic) and has an intramyocardial course approx-
imately to the level of the upper to mid-septum; the
involved coronary often gives rise to septal perfora-
tors before arising back to an epicardial location.20
The segment of the artery that traverses the septum
could be of a narrow caliber. The transeptal course
is considered a relatively benign course but has
been reported as potentially fatal.20
orly between the aortic root and the left atrium (Fig.
10), in a nonmalignant course. This is the most
frequently encountered anomalous course, seen in
up to 0.9% of the population particularly for the
LCX arising from either the right sinus of Valsalva
or the RCA. Some authors have postulated that ath-

the origin and proximal anatomic course, but also the pres-
ence of any atherosclerotic disease within that artery.
Coronary anomalies can generally be divided into anoma-
lies of origin and course, anomalies of intrinsic coronary ar-
terial anatomy, and anomalies of termination.7,13-16

Anomalies of Origin and Course

i. Anomalous location of the coronary ostium
a. High ostium: the ostium is considered to be high
when it is located least 1 cm above the sinotubular
junction17 (Fig. 12). Although this entity does not
cause any hemodynamic compromise, a high os-
tium may be difficult to cannulate at catheteriza-
tion, particularly that of the RCA.
b. Commissural ostium: an ostium is considered to be
commissural when it arises within 5 mm of the
commissure between two sinuses. This has been
reported in 6% of adult hearts.18
ii. Anomalous origin of the coronary artery from the op-
posite sinus: When an anomalous coronary artery
arises from the opposite coronary sinus, it can take one
of the following four courses.
a. Interarterialthe so-called malignant course: A
high risk of sudden cardiac death has been reported
for an anomalous coronary artery arising from the Figure 12 High ostium. 3D volume-rendered coronary tree CT dem-
opposite sinus and taking an interarterial course onstrating the RCA arising (13 mm) above the sinotubular junction.
between the aortic root and the pulmonary artery The short arrow depicts the normal location of the left coronary
or right ventricular outflow tract (RVOT) (Fig. 9). artery ostium. (Color version of figure is available online.)
Anatomy of the coronary arteries 107

Figure 13 Transeptal course. (A) An axial 5-mm MIP demonstrating the LAD originating from the right sinus of Valsalva
and taking a subpulmonic course as the dives down into the interventricular septum. (B) A sagittal reformat demon-
strates the intramyocardial course of the LAD in the proximal septum before. (C) Traversing back to the epicardial
surface of the heart more distally and is surrounded by epicardial fat.

erosclerotic disease prematurely affects the ret-
roaortic LCX and is more severe.21
d. Prepulmonicis a nonmalignant course that
does not compromise flow. The involved coronary
artery, usually the LM, LAD, or LCX, courses ante-
rior to the pulmonary artery or right ventricular
outflow tract (Fig. 11). The prepulmonic segment
of the artery is long as it courses anterior to the
pulmonary artery or right ventricular outflow tract.
This anomaly may often be seen in patients with
Tetralogy of Fallot.22
iii. Anomalous origin of the coronary artery from the pul-
monary artery (Fig. 14): A rare but lethal anomaly
presents in early infancy with an incidence of 1 in
300.000 live births.13 Extensive collaterals develop be-
tween the right and left coronary arterial systems and

Figure 14 Coronary artery arising from the pulmonary arteryaxial CT. (A) The LM is dilated as it arises from the LSV.
Note the dilated RCA in the anterior AV groove at a higher location than normal. Multiple collateral vessels are seen
(arrows); these were between the right and left coronary arterial systems. (B) The RCA arises from the pulmonary artery.
Note a large bronchial artery collateral from the descending thoracic aorta (arrowheads).
108 S. Patel

over time the flow reverses causing myocardial isch-

emia and congestive heart failure due to coronary steal
phenomenon into the fistula from the normal coronary
artery. By 4 months of age the majority of infants are in
congestive heart failure and 90% die within the first
year of life. Either the left main, LAD, or LCX arises
from the pulmonary artery. In the most common form
the LM arises from the pulmonary artery, and the RCA
has a normal origin in the right coronary sinus (Bland
WhiteGarland syndrome).23 This entity is often
treated surgically. Occasionally the right coronary ar-
tery can arise from the pulmonary artery with multiple
collaterals developing between the right and left coro-
nary arteries.
iv. Miscellaneous14
a. Single coronary artery: A rare anomaly, the entire
heart is supplied by the single coronary artery. A
single coronary artery may give rise to both the RCA
and the LM (Fig. 15) or may directly give rise to
three vessels, the RCA, LAD, and LCX, with one or
more of the vessels taking an anomalous course.
b. Multiple ostia: the most common anomaly that ac-
counts for multiple ostia is an absent left main with
separate origins of the LAD and LCX directly from
the LSV. When the left coronary artery and its Figure 16 Multiple ostia. 3D volume-rendered coronary tree image
branches arise from the opposite sinus, there may demonstrating three vessels arising from the RSVnormally lo-
be three or four ostia within the right sinus for the cated ostium of the RCA which follows a normal course; abnormally
RCA, LAD, and LCX (Fig. 16). Multiple ostia may located ostium for the LAD in the RSV, the LAD takes a subpul-
be difficult to recognize and cannulate at angiogra- monic transeptal course note the narrow caliber of the LAD. (Color
phy. version of figure is available online.)
c. Anomalous origin of the coronary artery from the
noncoronary sinus: Anomalous origin of the RCA
or LM from the noncoronary sinus is rare and of no transposition of the great arteries and anomalous
clinical relevance. An association exists between origin of the coronary from the noncoronary si-
nus.13
d. Duplication of coronary arteries: this is more com-
monly seen with the LAD or RCA than the LCX.
Duplication of the LAD is seen in 0.13 to 1% of the
population. This entity consists of a short LAD
that terminates in the proximal anterior interven-
tricular groove and a long LAD that enters the
distal anterior interventricular groove and
reaches the apex of the heart (Fig. 17). It is im-
portant to recognize this variant as the LAD is
often used for revascularization procedures and
recognizing this variant can aid the surgeon in
the correct positioning of the distal arteriotomy
site. The long LAD may take one of four courses
before it enters the distal septum24: to the left of
the anterior interventricular septum (AIVS), to
the right of the AIVS, an intramyocardial course,
or arising from the RCA and coursing anterior to
the RVOT before entering the distal AIVS.

Figure 15 Single coronary artery. Axial CT demonstrating a single

Anomalies of Intrinsic
vessel (LM) arising from the LSV and giving rise to the RCA that Coronary Arterial Anatomy
takes an interarterial course between the RVOT and aortic root. a. Congenital osteal stenosesOstial stenosis may be seen
Note that the interarterial RCA is of narrow caliber. when the RCA arises from the LSV and takes an inter-
Anatomy of the coronary arteries
Figure 17 Arterial duplication. 3D volume-rendered CT of the heart
demonstrating a short LAD that courses and terminates in the mid
septum. The long LAD courses to the left of the anterior interven-
tricular groove and enters the distal septum running inferiorly to the
apex of the heart and curving around it. (Color version of figure is
available online.)
arterial course. It is important to recognize the nar-
rowed proximal intramural portion of the coronary artery
when compared with the normal diameter of the distal
extramural vessel. This entity is better evaluated at intra-
vascular ultrasound. This intramural portion may be tan-
gentially orientated as it passes through the wall and is not
only smaller in diameter but on cross-section views is of-
ten of oval shape (Fig. 18) rather than round.25
b. Coronary artery ectasia or aneurysm defined as cor-
onary artery dilation more than 1.5 times that of the
adjacent normal segment has an incidence of 1.2 to 5%.
The coronary artery may be diffusely dilated or may have
a focal dilated segment. Nonatherosclerotic diffuse dila-
tion of the coronary arteries is usually secondary to wall
abnormality due to medial degeneration. Worldwide, Ka-
wasakis disease is the most common cause of aneurysms
of the coronary arteries, whereas atherosclerotic disease is
the most common etiology in the United States. With the
latter etiology there is a high association of coronary artery
stenosis. Even patients with nonatherosclerotic diffuse ec-
tasia/aneurysm have an increased risk of myocardial in-
farction and angina, postulated to be due to slow blood
109
flow and embolization due to mural thrombus formation
within the aneurysm.26
c. Myocardial bridgingintramyocardial course of the
coronary artery: The coronary artery normally runs
along the epicardial surface of the heart and is sur-
rounded by epicardial fat. When a short segment of the
coronary artery enters the myocardium (Fig. 19A) for a
variable length before coursing back onto the epicardial
surface of the heart (Fig. 19B), it is often referred to as
myocardial bridging or tunneled segment and has
been reported in 15 to 85% on autopsy studies.27 Com-
plete myocardial bridging in up to 20% of people is
diagnosed at catheter angiography by the systolic com-
pression of the tunneled segment.27 Incomplete myo-
cardial bridging is seen when the coronary artery
closely touches the myocardium but does not enter it,
and superficial myocardial bridging when the artery is
surrounded by only a thin layer of myocardium. The
likelihood of ischemia increases with the depth of the
bridged segment. Myocardial bridging commonly in-
volves the mid portion of the LAD but may involve the
RCA, LCX, diagonals, or obtuse marginals. This entity
is easily detected on CT, particularly on the cross-sec-
tion thin MIP images, and is seen in 5-30% of CT cor-
onary angiography (CTCA) studies.28 The tunneled
segment is often spared from atherosclerotic disease,
although the presence of atherosclerosis is frequently
seen in the segment proximal to the bridge. Myocardial
bridging is considered a relatively benign finding; how-
ever, may rarely cause severe ischemia.
Anomalies of Termination
a. Congenital coronary artery fistula (CAF): An abnormal
communication is present between a coronary artery,
bypassing the myocardial capillary bed and entering
any one of the four cardiac chambers or the pulmonary
(coronary arteriovenous) (Fig. 20) or systemic circula-
tion (coronary-cameral). Coronary artery fistulas are
rare, seen in 0.1 to 0.4% of patients at cardiac catheter-
Figure 18 Ostial hypoplasia/congenital stenosis. Orthogonal cross-
sectional images of the RCA as it arises from the left sinus of Val-
salva. (A) The proximal RCA at its origin is of narrow caliber and
oval in shape. (B) One centimeter distal to its origin, the RCA has a
normal round shape and is of normal caliber.
110
Figure 19 Myocardial bridging. (A) Curved reformat of the LAD demonstrates a long segment of the mid LAD demon-
strating an intramyocardial course (arrowheads). (B) On the cross-sectional orthogonal MIP view the tunneled artery
(arrow) is surrounded by muscle.
ization.29 The involved coronary artery is dilated and
may have a single (most common) or multiple com-
munications at its distal drainage site.28 Most fistulae
arise from the RCA and drain into the right heart
chambers. The right ventricle is the most common
site of drainage followed by the right atrium, coro-
nary sinus, and the pulmonary artery. A small fistula
may be of no consequence, whereas a large fistula
may increase in size over time and may have a serious
clinical outcome, due to myocardial steal phenome-
non or decreased myocardial blood flow distal to the
fistulous connection, arrhythmias, congestive heart
failure, or aneurysm formation.
b. Extracardiac termination: rarely, the coronary arteries
may terminate in extracardiac vessels such as bron-
chial, internal mammary, phrenic, or intercostals
arteries.
Image Analysis
and Interpretation
It is important to review each coronary artery in a systematic
fashion from origin to termination. A lot of information can
be gathered from the axial source images (Fig. 1). When
scrolling through the axial images, the left coronary ostium is
visualized cranial to the RCA ostium, predominantly in the
middle to top half of the left coronary sinus. On axial images,
the right ostium is seen caudal to the left coronary artery
origin as it arises from its respective sinus. Evaluation should
include assessment of ostial location within the respective
sinus/opposite sinus, ostial location above the sinotubular
ridge (high-takeoff), ostial configuration (round, oval, or slit-
like), and number of ostia from the left and right sinus, re-
S. Patel
spectively. When the coronary artery does not arise from its
respective sinus, evaluate the opposite or noncoronary sinus
for possible anomalous origin of a coronary artery. The
course of each coronary artery should then be followed in
turn, to determine whether it follows a normal or anomalous
course (interarterial, transeptal, prepulmonic, or retroaortic).
It is usually the proximal portion of the artery that follows an
anomalous course; the distal distribution is normal. Maxi-
mum intensity projection (MIP) images are useful in evaluat-
ing the number of ostia, the anatomic course, particularly the
intramyocardial course or transeptal course, as well as the
intramural portion of the coronary artery which on cross-
section views may appear oval, slit-like, or round. The caliber
of the anomalous coronary artery can also be better evaluated
on the MIP views and compared with the caliber of the distal
vessel. The interarterial or transeptal portion of an anomalous
vessel may be of smaller caliber when compared with the
vessel distal to this area. Volume-rendered images are useful
to evaluate the origin (sinus versus opposite coronary artery)
and the number of ostia as well as the epicardial course of the
coronary arterieswhich is exquisitely depicted in some pa-
tients (Figs. 11 and 17). The shape and number of ostia are
also well seen on endoluminal views. Besides evaluating the
origin, course, and caliber of the anomalous vessel, it is im-
portant to analyze the vessel for atherosclerotic disease caus-
ing luminal stenosis due to calcified, noncalcified, or mixed
plaque.
Conclusion
This article has reviewed the normal anatomy of the coronary
arteries that every physician should be familiar with when
interpreting coronary CT examinations. The article also re-
Anatomy of the coronary arteries
Figure 20 Coronary artery fistula (CAF). (A) 3D volume-rendered tree image demonstrates a small fistulous connection
from the LAD that terminated in the pulmonary artery. (B). 3D volume-rendered of the heart demonstrates the surface
anatomy of the coronary artery fistula from the LAD to the pulmonary artery. (Color version of figure is available
online.)
views the common and uncommon coronary artery anoma-
lies and their prevalence. While rare, these coronary artery
anomalies can potentially cause symptoms in a small number
of patients and are often fatal. It is therefore important to
recognize the anomalies and be aware of their significance.
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