Intramyocardial Left Anterior Descending Artery Extending Toward the Right Ventricle Demonstrated on Coronary CT Angiography

Intramyocardial coronary artery course is a rare anatomical variant that can be increasingly recognized with coronary computed tomography angiography (CCTA). We present the case of a 22-year-old male who underwent CCTA for evaluation of chest pain. Imaging demonstrated an unusual course of the left anterior descending artery (LAD), which traversed toward the right ventricular cavity over an approximately 21 mm segment. Multiplanar reconstructions and three-dimensional volume-rendered images clearly depicted the intramyocardial trajectory of the vessel. Although usually asymptomatic, recognition of this variant is important because intramyocardial coronary arteries may be vulnerable to injury during intracardiac procedures. This case highlights the role of CCTA in accurately characterizing a rare intracavitary LAD course with clear delineation of its intramyocardial-to-intracavitary trajectory toward the right ventricle using multiplanar and three-dimensional reconstructions.