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Background
While most vascular anomalies elsewhere in the body do not have clinical importance, coronary vascular anomalies can have significant cardiovascular consequence resulting in myocardial infarction, arrythmias, heart failure or sudden cardiac death. Hemodynamically significant anomalies such as a fistula can cause shunting from one region of the myocardium or chamber to another. Coronary artery anomalies may also be associated with congenital heart diseases that should prompt further evaluation with either cardiac MRI or an echocardiogram.

Educational Goals / Teaching Points
In this presentation, we briefly review the normal anatomy of the coronary artery and its branches. We then discuss various classifications of coronary artery anomalies with emphasis on recognizing hemodynamically significant from insignificant anomalies. We will then discuss prognosis and management of hemodynamically significant anomalies.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
In this educational exhibit, we will review imaging findings on cardiac gated CT with MRI correlation, if available, related to coronary artery anomalies through a systematic case-based review. We will present cases of hemodynamically significant anomalies including coronary artery fistula, myocardial bridging, and malignant/interarterial anomalous origin. We will also present cases of hemodynamically insignificant anomalies including LM quadrification, coronary artery ectasis and aneurysm, benign anomalous origins, and PDA dominance such as super dominant and LAD dominant PDA.

Conclusion
Radiologists should be familiar with coronary artery anomalies, as some can be clinically significant and require surgical or medical intervention. A delay in diagnosis and treatment could cause strain on the heart and eventual development of congestive heart failure, cardiac arrythmias, or death.