Rare congenital coronary artery anomalies diagnosed by coronary CT angiography: A 4-case series

Congenital coronary artery anomalies (CCAAs) are uncommon but may cause myocardial ischemia, arrhythmias, or sudden cardiac death. Coronary computed tomography angiography (CCTA) provides precise, noninvasive assessment of these variants. We report 4 rare CCAA cases detected by CCTA: (1) coronary cameral fistula from the left coronary artery (LCA) to the left ventricle with associated myocardial bridging; (2) interarterial course of the right coronary artery (RCA) between the aorta and pulmonary artery; (3) congenital absence of the RCA with a dominant left system; and (4) dual RCAs. Three patients presented with exertional chest pain, one was found incidentally. All were managed conservatively based on absence of hemodynamic compromise and low ischemic risk; symptoms resolved or improved on follow-up (3-12 months). This series illustrates the spectrum of rare CCAAs and emphasizes CCTA's role in differentiating malignant from benign variants, guiding management, and avoiding unnecessary interventions.