Anomalous Coronary Arteries on Computer Tomography Angiography: a Pictorial Review

Purpose of Review: Coronary artery anomalies (CAA) are a commonly encountered entity on computer tomography angiography (CTA) with observational studies suggesting a prevalence of 1–3%. The purpose of this pictorial review is to succinctly review the recent literature in regards to their individual prevalence, assessment and management strategies when indicated. Recent Findings: Clinically, the most important anomalies are those with either a malignant course or origin. Recent studies have suggested that anomalous coronary arteries arising from the opposite sinus (ACAOS) are best detected on CTA. In particular, those found in asymptomatic patients over the age of 35, even with high-risk features, do not necessarily mandate revascularisation. We propose a new investigative framework. Additionally, new CTA prevalence data has emerged of individual anomalies which are further discussed. Summary: Computer tomography angiography has emerged as the gold standard for the assessment of CAAs, and as a result, they are being encountered more frequently in clinical practice. It is important that reporting physicians have a comprehensive knowledge of these anomalies, how they are best described and categorised and particularly recognition of malignant variants that may require intervention.