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Anomalous origin of a coronary artery is uncommon but clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, syncope, arrhythmias, and sudden cardiac death. We herein describe a rare case of an anomalous origin of the RCA with malignant course between aorta and pulmonary artery. Angiography is invasive, have a relatively low cannulation success rate. Therefore, CT coronary angiography is the best method for imaging. Sudden death without symptoms occurs frequently in patients with anomalous RCAs, so surgical repair is recommended.
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