We present the imaging series of a 52-year-old woman with no cardiovascular risk factors who was admitted for acute coronary syndrome without persistent ST elevation (NSTEMI). Coronary angiography and cardiac computed tomography demonstrated anomalous origination of the coronary artery from the opposite sinus (ACAOS), which is an uncommon coronary anomaly; the incidence is about 1.07% in general, and only 0.12%-0.9% in the case of right ACAOS. The clinical consequences can be relevant if the ectopic artery has intramural intussusception or courses between the aorta and pulmonary artery.
Keywords: acute coronary syndrome; anomalous origin of right coronary artery; cardiac computed tomography; coronary angiography; coronary artery anomaly.