Echocardiogram-Guided Diagnosis of Anomalous Coronary Arteries: A Rare Presentation

Abstract

Incidentaloma, a term that embodies the detection of certain problems during the performance of unreasonable investigations, resonates in the medical field. Retroaortic coronary sign is a recently recognized echocardiographic feature of the anomalous coronary artery. It is typically associated with anomalies of the left coronary artery, especially the left circumflex artery. As far as has been monitored, few echocardiographic signs that correlate with this feature have been identified. This feature often remains underdiagnosed on transthoracic echocardiograms due to confusion with artifacts, calcifications, and other cardiac structures. A 45-year-old male patient underwent regular cardiac routine assessment. Retroaortic anomalous coronary (RAC) sign was incidentally detected by transthoracic thoracic echocardiogram; consequently, the retroaortic route of the coronary artery was suspected. Coronary computed tomography angiography was requested to confirm the seen echocardiographic signs. After a 3D reconstruction imaging, the left circumflex retroaortic course was identified with right coronary sinus origin. This case ensures the importance of transthoracic echocardiography as a noninvasive tool in diagnosing anomalous coronary arteries. These anomalies are usually diagnosed by coronary computed tomography angiography and coronary angiography, mainly in the presence of retroaortic coronary sign or "crossed aorta sign."

Keywords: anomalous coronaries; asymptomatic; coronary computed tomoangiography; echography of the heart; incidental radiological finding.

Figure 1. Conventional transthoracic parasternal long-axis view showing a small circle beneath the non-coronary cusp.

Transthoracic bleb sign indicated by arrow. LV: Left ventricle; MV: Mitral valve; AV: Aortic valve.

Figure 2. Cardiac CT with 3D reconstruction.

The two black arrows indicate a retroaortic artery arising from RCS near the right coronary artery directed toward the atrioventricular groove. RCS: Right coronary sinus; RCA: Right coronary artery (925*489 DPI 300)

Figure 3. 3D reconstruction cardiac CT.

Left circumflex retroaortic artery arising near the right coronary artery with posterior trajectory (900*489 DPI:300). LCX: Left circumflex; RCA: Right coronary artery.

Figure 4. 3D reconstruction cardiac CT image.

The left main artery gives rise to one branch, which is the left anterior descending artery. LAD gives three diagonal branches (D1, D2, and D3). LAD: Left anterior descending; LM: Left main; D: Diagonal artery (1667*900 dimensions, DPI 300).