0:01

Okay case two.

0:03

patient again presenting with chest pain

0:07

This is a single image take a look at this image and see if you

0:10

can identify.

0:11

the abnormality

0:18

Okay.

0:19

this is a

0:21

transaxial CTA

0:25

Right through the aortic root.

0:27

And we can see coronary arteries

0:30

arising from the the root

0:33

in particular. They're all arising from

0:36

the left science of el Salva, which is

0:39

this bulge.

0:40

The vessels that arising from

0:43

the left sinus of valsalva or the left main which in turn gives

0:46

rise to Lad.

0:47

And the circumflex looks

0:50

like another example of a ramus

0:53

intermedius. We're not seeing the circumflex on

0:56

this single image, but it also gives rise

0:59

to the right coronary artery.

1:02

And this is the pathology in

1:05

this case. It's obviously A congenital abnormality.

1:08

But in this case, it's a

1:11

malignant abnormality. Meaning

1:14

that this is associated with worse outcome and

1:17

in contrast distinction

1:20

to benign anomalous vessels.

1:23

This malignant RCA can lead to

1:26

sudden cardiac death or myocardial infarction.

1:30

And needs to be brought to

1:33

the attention of a cardiologist and potentially a

1:37

cardiac surgeon if indicated. So

1:40

this is malignant. If a coronary

1:43

artery anomaly passes

1:46

between the ascending aorta and the

1:49

main pulmonary artery or RV Alpha track

1:52

that is considered malignant.