CTICasesAnomalous Left Coronary Artery from Pulmonary Artery (ALCAPA) in an Asymptomatic Adult
[...]. Anomalous Left Coronary Artery from Pulmonary Artery (ALCAPA) in an Asymptomatic Adult. CTICases. Published September 9, 2016. https://str-case-explorer.pages.dev/c/rfjba
Imaging findings
CT reveals markedly dilated coronary arteries, calcification of the papillary muscles, and subendocardial fat deposition within the LAD territory. A timing bolus demonstrates left-to-right shunt physiology with early opacification of the pulmonary artery and a characteristic "puff" of non-opacified blood arising from the left coronary artery, indicating steal phenomenon. Myocardium also shows numerous small vessels.
Key takeaways
This is an impressive and rare case of Anomalous Left Coronary Artery from Pulmonary Artery (ALCAPA) presenting in an asymptomatic, active adult, highlighting the potential for long-term survival due to extensive collateral development. The case beautifully demonstrates the physiology of ALCAPA on CT, including left-to-right shunting, coronary steal phenomenon, and signs of chronic myocardial ischemia.
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