Anomalous origin of the left coronary artery can lead to angina pectoris, acute myocardial infarction or even sudden death, especially during exercise. We present a patient in whom the anomalous origin of the left coronary artery from the posterior aortic (non-coronary) sinus produced ischemic chest pain. The anomaly was identified by transesophageal echocardiography (TEE) and magnetic resonance imaging (MRI) as well as by coronary angiography. TEE and MRI are useful for detecting anomalies of the coronary artery both clearly and noninvasively and for evaluating the mechanism of ischemia.