Short Chronic Total Occlusion Stump Creating an Optical Illusion of an Anomalous Coronary Artery: A Pseudo Anomaly

Coronary artery anomalies are often asymptomatic and detected incidentally during coronary angiography, cardiac surgery, or autopsy. However, sometimes in chronic total occlusion, the distal part of a vessel is well collateralized from the contralateral vessel that it appears almost as an anomalous coronary artery. Here, we discuss a rather interesting angiogram which at first instance, looked like a case of a dual left anterior descending (LAD) artery with anomalous origin of the LAD from the proximal right coronary artery, but after further evaluation appeared to be a case of an occluded LAD filling through Vieussens' arterial ring.