Detection of a double right coronary artery with 16-row multidetector computed tomography

Abstract

We present the case of a 46-year-old male patient with known history of coronary artery disease and recurrent episodes of angina pectoris. Coronary angiography revealed two vessels originating from the right coronary sinus. However, a clear distinction between a double RCA and a high take off of a large right ventricular branch could not be made. Contrast-enhanced MDCT was performed on a 16-row scanner which clearly depicted cardiac anatomy and finally established the diagnosis of a double RCA. To our knowledge, this is the first report of a true double RCA diagnosed by MDCT.

Anatomic study of the morphology of the right and left coronary arteries

“…In addition, the presence of coronary variations such as double or split RCA and absent LCA was documented. The RCA was classified as double or split when two separate branches of the RCA were found running together for at least half the course of the RCA [23]. A split RCA could originate from either a single proximal trunk or separate orifices [25].…”

“…In their study, the two vessels arose from separate adjacent coronary ostia with the smaller vessel providing the PIB and the larger vessel continuing as the right marginal branch [23]. Nair et al [26] described a double RCA arising from a single coronary ostium where both vessels of the RCA ran parallel in the right atrioventricular groove and crossed the crux of the heart.…”

“…Branching from the aorta, the right (RCA) and left (LCA) coronary arteries supply the myocardium and epicardium of the heart [24]. Arising from the right aortic sinus, the RCA descends in the coronary sulcus [23]. The RCA gives off a right marginal branch, running towards the apex of the heart, before proceeding to the posterior aspect of the heart [24].…”

“…Both vessels coursed in the interventricular sulcus but did not cross the crux. Lemburg et al [23] described a true double RCA, of which both vessels had similar diameters and originated from two separate adjacent coronary ostia in the right coronary sinus. Double RCA were also described as two separate branches of the RCA in the atrioventricular groove running closely together for half the course of the RCA [23].…”

“…Lemburg et al [23] described a true double RCA, of which both vessels had similar diameters and originated from two separate adjacent coronary ostia in the right coronary sinus. Double RCA were also described as two separate branches of the RCA in the atrioventricular groove running closely together for half the course of the RCA [23]. In addition, the double RCA can originate from a single proximal trunk or separate orifices from the right aortic sinus and can exhibit two distinct PIBs or a single PIB [25].…”