Single ostium co
rona
ry a
rte
ry is a
ra
re co
rona
ry a
rte
ry anomaly. It is
repo
rted to occu
r in only 0.0448% of cases who unde
rwent invasive co
rona
ry angiog
raphy. It can be associated with angina, a
rrhythmias, and possibly sudden death and is a clinically impo
rtant entity to
rule out in patients p
resenting with chest pain. We
repo
rt the case of a 68-yea
r old man who p
resented with wo
rsening
resting chest pain and unde
rwent invasive co
rona
ry angiog
raphy and a single ostium co
rona
ry a
rte
ry was identified. Subsequent co
rona
ry computed tomog
raphy (CT) angiog
raphy
revealed it to be a unique va
riation of class R-III of
Lipton classification of single ostium co
rona
ry a
rte
ry. Lipton R-III single ostium co
rona
ry a
rte
ry is
ra
re and its incidence is
repo
rted to be 0.004% in patients who had invasive co
rona
ry angiog
raphy. In ou
r case, anomalous left co
rona
ry ci
rcumflex a
rte
ry was
ret
roao
rtic cou
rse combined with int
ramyoca
rdial cou
rse. It also divided into multiple obtuse ma
rginal b
ranches in the myoca
rdium and neve
r cou
rsed along the ante
rio
r and late
ral aspects of the a
rte
riovent
ricula
r g
roove. This va
riation has not been
repo
rted in the lite
ratu
re. Co
rona
ry CT angiog
raphy played an essential
role to delineate this complex co
rona
ry anomaly.
r0010"><rong class="boldFont">Learning objective:rong> Single ostium coronary artery is a rare coronary artery anomaly. However, it is a clinically important entity to rule out in the evaluation of patients with chest pain. Invasive coronary angiography can identify this anomaly; however, coronary computed tomography angiography is recommended to fully characterize this condition as demonstrated in our case. Depending on the detailed anatomical information of the anomaly, the clinical management needs to be tailored for these cases.>