**Introduction/Hypothesis:**
Coronary artery anomalies is a broad term used to encompass variations in coronary anatomy present in less than 1% of the population. Identification of these anomalies is critical as it is the second most common cause of exercised-induced cardiac death in young athletes. Here we discuss the role of Cardiac CT Angiography in diagnosis, anatomic correlations, and surgical approach.

**Methods**
A 37 y/o female with no significant past medical history presented to the emergency room for evaluation of sudden onset of chest pain. Patient described the pain as a 8/10 in intensity, sharp, localized to the left chest with radiation to the left arm. ECG and troponin levels were within normal limits. Symptoms were not relieved with sublingual nitroglycerine. Patient was referred for further cardiac workup which revealed an anomalous main Left Coronary Artery (LCA) arising from the Right Sinus of Valsalva on Cardiac CT Angiography.

**Results**
N/A

**Conclusion**
The present review focuses on the anomalous origination of the main LCA from the right sinus of Valsalva instead of the left. Anomalous origination of a coronary artery from the opposite sinus is the subgroup with the most potential clinical repercussions due to high risk of sudden cardiac death. Patients who are symptomatic are candidates for medical treatment and surgical pair. Multidisciplinary protocols dedicated to coronary artery anomalies has been associated with optimal prognosis and treatment outcomes.



Anomalous Left Coronary Artery Detection with CT Angiography