Multimodal Imaging of an Incidental Anomalous Coronary Artery

Anomalous right coronary artery arising from the main pulmonary artery (ARCAPA) is commonly identified on an incidental basis in asymptomatic individuals. This case report of an adult male patient admitted with troponin-positive chest pain highlights the incidental nature via which ARCAPA may present. Invasive coronary angiography suggested a potential anomalous right coronary origin, before computed tomography (CT) coronary angiography confirmed ARCAPA while also identifying extensive, acute bilateral pulmonary emboli, in itself sufficient to explain the presentation. Stress perfusion cardiac magnetic resonance imaging (MRI) accordingly excluded both myocardial infarction and inducible hypoperfusion. We discuss multimodal investigation in the management of incidental ARCAPA.