Case Report: Bilateral Pneumothoraces Due To Targeted Tumor Therapy With Regorafenib in a Young Woman With Metastatic Colorectal Cancer

Abstract Background: Colorectal cancer is one of the most common cancer types, frequently metastasizing into the lungs. Treatment options have been vastly improved over the last years. With the increasing use of targeted therapies novel and rare adverse effects can be seen. In this report, we present the case of recurrent spontaneous bilateral pneumothorax due to fulminant tumor necrosis during the administration of regorafenib in a heavily pretreated patient with multiple lung metastases from colorectal cancer. Case presentation: A 43-year-old woman presented in our oncology department with chest pain and dyspnea. The patient was diagnosed with colorectal cancer seven years earlier and had received chemoradiation, surgery and multiple chemotherapies, before she was started on regorafenib because of progressive pulmonary metastases. Clinical examination revealed no breath sounds in the right hemithorax. The patient was tachycardic and orthopneic. Computed tomography scans demonstrated cavitation of former nodular bilateral pulmonary metastases. After drainage and resolution of the right-sided pneumothorax the patient returned eleven days later with recurrent dyspnea, chest pain and subcutaneous emphysema. Bilateral pneumothoraces were treated with chest tubes. Due to left-sided tension pneumothorax video-assisted thoracoscopy and bilateral pleurodeses were performed. Persistent air leaks with severe pain and pulmonary infiltrates led to the death of the patient. Conclusions: Our case illustrates the effectiveness of regorafenib in a highly pretreated patient. However, in our patient the ensuing cavitation of the multiple nodes led to recurrent pneumothoraces and associated infectious complications. Therefore, special surveillance should be implemented to detect potential transformation of solid pulmonary metastases during treatment with this multi-kinase inhibitor.

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Electrocardiographic manifestations in a large right-sided pneumothorax

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01470-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hiroyuki Yamamoto ◽

Kazuhiro Satomi ◽

Yoshiyasu Aizawa

Keyword(s):

Chest Pain ◽

Tension Pneumothorax ◽

Ambient Air ◽

P Wave ◽

Ct Scans ◽

Maximum Diameter ◽

Initial Examination ◽

Breath Sounds ◽

The Right ◽

Ecg Abnormalities

Abstract Background Pneumothorax is an extrapulmonary air accumulation within the pleural space between the lung and chest wall. Once pneumothorax acquires tension physiology, it turns into a potentially lethal condition requiring prompt surgical intervention. Common symptoms are chest pain and dyspnea; hence an electrocardiogram (ECG) is often performed in emergent settings. However, early diagnosis of pneumothorax remains challenging since chest pain and dyspnea are common symptomatology in various life-threatening emergencies, often leading to overlooked or delayed diagnosis. While the majority of left-sided pneumothorax-related ECG abnormalities have been reported, right-sided pneumothorax-related ECG abnormalities remain elucidated. Case presentation A 51-year-old man presented to the emergency department with acute-onset chest pain and dyspnea. Upon initial examination, the patient had a blood pressure of 98/68 mmHg, tachycardia of 100 beats/min, tachypnea of 28 breaths/min, and oxygen saturation of 94% on ambient air. Chest auscultation revealed decreased breath sounds on the right side. ECG revealed sinus tachycardia, phasic voltage variation of QRS complexes in V4–6, P-pulmonale, and vertical P-wave axis. Chest radiographs and computed tomography (CT) scans confirmed a large right-sided pneumothorax. The patient’s symptoms, all the ECG abnormalities, and increased heart rate on the initial presentation resolved following an emergent tube thoracostomy. Moreover, we found that these ECG abnormalities consisted of two independent factors: respiratory components and the diaphragm level. Besides, CT scans demonstrated the large bullae with a maximum diameter of 46 × 49 mm in the right lung apex. Finally, the patient showed complete recovery with a thoracoscopic bullectomy. Conclusions Herein, we describe a case of a large right-sided primary spontaneous pneumothorax with characteristic ECG findings that resolved following re-expansion of the lung. Our case may shed new light on the mechanisms underlying ECG abnormalities associated with a large right-sided pneumothorax. Moreover, ECG manifestations may provide useful information to suspect a large pneumothorax or tension pneumothorax in emergent settings where ECGs are performed on patients with acute chest pain and dyspnea.

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Survival case of acute and severe respiratory distress due to spontaneous tension gastrothorax

BMJ Case Reports ◽

10.1136/bcr-2020-235281 ◽

2020 ◽

Vol 13 (9) ◽

pp. e235281

Author(s):

Sanjan Asanaru Kunju ◽

Prithvishree Ravindra ◽

Ramya Kumar Madabushi Vijay ◽

Priya Pattath Sankaran

Keyword(s):

Tension Pneumothorax ◽

Emergency Laparotomy ◽

Severe Respiratory Distress ◽

Mediastinal Shift ◽

Breath Sounds ◽

Chest X Ray ◽

The Right ◽

Tension Gastrothorax ◽

Obstructive Shock ◽

Survival Case

A 20-year-old woman presented with abdominal pain and shortness of breath. She was in obstructive shock with absent breath sounds on the left haemithorax. Chest X-ray showed a large radiolucent shadow with absent lung markings and mediastinal shift to the right side with concerns for tension pneumothorax. Though tube thoracostomy was done on the left side of the chest, column movement was absent. To confirm the diagnosis CT with contrast was done that revealed a huge left side diaphragmatic defect with abdominal contents in the thorax and mediastinal structures are shifted to left. She underwent emergency laparotomy and postoperative period was uneventful.

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Role of Thermal Ablation in Colorectal Cancer Lung Metastases

Cancers ◽

10.3390/cancers13040908 ◽

2021 ◽

Vol 13 (4) ◽

pp. 908

Author(s):

Alexandre Delpla ◽

Thierry de Baere ◽

Eloi Varin ◽

Frederic Deschamps ◽

Charles Roux ◽

...

Keyword(s):

Colorectal Cancer ◽

Prognostic Factors ◽

Thermal Ablation ◽

Medical Oncology ◽

Pulmonary Metastases ◽

Lung Metastases ◽

Stereotactic Ablative Radiotherapy ◽

Chest Drainage ◽

Results Of Surgery

Background: Consensus guidelines of the European Society for Medical Oncology (ESMO) (2016) provided recommendations for the management of lung metastases. Thermal ablation appears as a tool in the management of these secondary pulmonary lesions, in the same manner as surgical resection or stereotactic ablative radiotherapy (SABR). Methods: Indications, technical considerations, oncological outcomes such as survival (OS) or local control (LC), prognostic factors and complications of thermal ablation in colorectal cancer lung metastases were reviewed and put into perspective with results of surgery and SABR. Results: LC rates varied from 62 to 91%, with size of the metastasis (<2 cm), proximity to the bronchi or vessels, and size of ablation margins (>5 mm) as predictive factors of LC. Median OS varied between 33 and 68 months. Pulmonary free disease interval <12 months, positive carcinoembryonic antigen, absence of neoadjuvant chemotherapy and uncontrolled extra-pulmonary metastases were poor prognostic factors for OS. While chest drainage for less than 48 h was required in 13 to 47% of treatments, major complications were rare. Conclusions: Thermal ablation of a selected subpopulation of patients with colorectal cancer lung metastases is safe and can provide excellent LC and delay systemic chemotherapy.

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Percutaneous radiofrequency ablation of inoperable pulmonary metastases from colorectal cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.3502 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 3502-3502

Author(s):

T. D. Yan ◽

J. King ◽

D. Glenn ◽

K. Steinke ◽

D. L. Morris

Keyword(s):

Colorectal Cancer ◽

Multivariate Analysis ◽

Radiofrequency Ablation ◽

Lung Metastasis ◽

Pulmonary Metastases ◽

Lung Metastases ◽

Univariate Analysis ◽

Prognostic Parameters ◽

Percutaneous Radiofrequency Ablation

3502 Background: This current study was an open, prospective and nonrandomized phase II study, which critically evaluated the prognostic parameters for local disease-free survival (DFS) and overall survival (OS) in patients who underwent percutaneous radiofrequency ablation (RFA) for inoperable colorectal pulmonary metastases (CRPM). Methods: The inclusion criteria were patients who had inoperable CRPM, due to number, distribution, poor performance status or patients’ refusal to accept surgery. The exclusion criteria were lesions > 6 per hemithorax; diameter of metastases > 5 cm; bleeding diathesis; and/or significantly compromised lung function. All patients underwent percutaneous RFA with a radiological clear margin of at least 2 cm. The end-points of this study were local DFS and OS, determined from the time of RFA intervention. Ten clinical and six treatment-related prognostic parameters were assessed in univariate and multivariate analyses. All patients were reviewed at one week, one month and every three months thereafter with chest CT. Fifty-five patients entered into the study. The follow-up was complete and the median follow-up was 24 months (6 to 40). Results: The median local DFS was not reached and 2-year local DFS was 57%. Univariate analysis demonstrated that largest size of lung metastasis, location of lung metastases, post-RFA CEA at 1 month and 3 months were significant for local DFS. In multivariate analysis, largest size of lung metastasis of ≤ 3 cm and post-RFA CEA of ≤ 5 ng/ml at 1 month were independently associated with an improved local DFS. The median OS was 33 months (4 to 40), with 1-, 2-, and 3-year survival of 85%, 64% and 46%, respectively. Univariate analysis demonstrated that interval between the diagnoses of colorectal cancer and pulmonary metastasis; largest size of lung metastasis and location of lung metastases were significant for OS. In multivariate analysis, only size of lung metastasis of ≤ 3 cm was independently associated with an improved OS. Conclusions: Percutaneous RFA of inoperable CRPM may have a useful role in patients with a lesion of ≤ 3 cm. No significant financial relationships to disclose.

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Local treatment combined with chemotherapy improves survival of patients with pulmonary metastases of colorectal cancer—a real-world retrospective study

10.21203/rs.3.rs-27518/v1 ◽

2020 ◽

Author(s):

Zikai Cai ◽

Qingbing Wang ◽

Xiaofeng Yang ◽

Xiaolong Ye ◽

Jiafeng Fang ◽

...

Keyword(s):

Colorectal Cancer ◽

Propensity Score ◽

Propensity Score Matching ◽

Pulmonary Metastases ◽

Lung Metastases ◽

Local Treatment ◽

Multivariable Analysis ◽

Progression Free Survival ◽

Cox Proportional Hazards ◽

Free Survival

Abstract Background The effect of local treatments for pulmonary metastases from colorectal cancer (CRC-PM) remains controversial. This study aims to figure out whether local treatments combined with chemotherapy could improve patients’ survival by comparing the outcomes of CRC-PM patients who submitted to local interventions combined with chemotherapy or just chemotherapy.Patients and Methods From January 2009 to July 2019, a total of 119 patients with CRC-PM from two surgical centers were reviewed. Patients were divided into two groups according to treatments for the lung metastases: Local intervention combined with chemotherapy (Group-LI) and Chemotherapy alone (Group-Chem). Overall survival (OS) and progression-free survival (PFS) were assessed with the Kaplan-Meier method. Clinical characteristics associated with prognosis were analyzed by using a Cox proportional hazards regression model. Propensity score matching analyses were used to overcome the possible biases in some baseline characteristics.Result Multivariable analysis revealed that the level of carcinoembryonic antigen (CEA) and treatment for CRC-PM are independent predictors of both OS and PFS. The median OS in Group-LI (n = 39) and Group-Chem (n = 80) were 34.5 months and 13.8 months, respectively(P < 0.001). The 3-year progression-free survival rate in Group-LI and Group-Chem were 75.2% and 45.1% (P < 0.001). After propensity score matching, patients in Group-LI had better OS (HR = 3.304, P = 0.022) and PFS (HR = 4.029, P < 0.001) than Group-Chem.Conclusion. CRC-PM patients with lower lever of CEA or local treatment of lung metastases are more likely to be those with favorable prognosis. Selected CRC-PM patients could benefit from local treatment of pulmonary metastases.

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Safety and efficacy of radiofrequency ablation for pulmonary metastases in metastatic colorectal cancer patients: A single center experience.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.141 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 141-141

Author(s):

Dong-Hoe Koo ◽

Hyun Pyo Hong ◽

Sukjoong Oh ◽

Yun-Gyoo Lee ◽

Kyung A. Kang ◽

...

Keyword(s):

Colorectal Cancer ◽

Radiofrequency Ablation ◽

Metastatic Colorectal Cancer ◽

Cancer Patients ◽

Pulmonary Metastases ◽

Lung Metastases ◽

Tumor Control ◽

Safety And Efficacy ◽

Extra Pulmonary ◽

Colorectal Cancer Patients

141 Background: Radiofrequency ablation (RFA) has been increasingly used for the treatment of pulmonary metastases from several types of malignancies. Methods: A retrospective analysis was performed for the safety and efficacy of percutaneous RFA in patients with metastatic colorectal cancer between October 2016 and June 2019 as well as assessing prognostic factors of local tumor control. Results: RFA was carried out for 48 lung metastases in 31 consecutive colorectal cancer patients. Male was 17 patients (55%), and the median age at RFA was 61 years (range, 42-81). The mean diameter of metastases targeted for RFA was 12 mm (range, 4-32), and 17 tumors (35%) were located in a sub-pleural or deep position. Although five cases (10%) were failed due to immediate complications, there was no procedure-related death. In terms of immediate complication, a total of 12 cases (25%) had events including nine pneumothorax (percutaneous drain in four), one pleural effusion, and two hemoptysis (ICU care in one). Delayed complications were lung abscess and diaphragm injury in each one patient, respectively. At the time of analysis, the median follow-up duration from RFA was 12.0 months (interquartile range, 6.5-23.1). Only two patients (6%) died of disease progression, and 3-year overall survival rate was 85.5% (95% CI, 75.5-95.5). RFA site progression was observed in 11 patients (23%), and 1-year and 2-year progression-free survival rates were 71.5% (95% CI, 58.7-84.3) and 56.6% (95% CI, 42.6-70.6), respectively. Multivariate analysis showed that extra-pulmonary progression (hazard ratio 17.49; p = 0.023) was only one independent prognostic factor associated with RFA site progression after adjusting for confounding factors including sex, age, performance, tumor size, location, contact with the vessel, last chemotherapy response, and duration. Conclusions: RFA is a comparatively safe and effective option for the treatment of small-sized lung metastases; however, the control of extra-pulmonary metastases should be accompanied for effective local control.

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Prevalence of Lung Metastases among 19,321 Metastatic Colorectal Cancer Patients in Eight Countries of Europe and Asia

Current Oncology ◽

10.3390/curroncol28060423 ◽

2021 ◽

Vol 28 (6) ◽

pp. 5035-5040

Author(s):

Markus S. Jördens ◽

Simon Labuhn ◽

Tom Luedde ◽

Laura Hoyer ◽

Karel Kostev ◽

...

Keyword(s):

Colorectal Cancer ◽

Pulmonary Metastases ◽

Lung Metastases ◽

Stage Iv ◽

Western World ◽

Uicc Stage ◽

Probability Of Survival ◽

Stage Iv Colorectal Cancer ◽

Metastatic Patterns ◽

Colorectal Cancer Patients

Background: Colorectal cancer is one of the most common malignancies in the Western world, and is responsible for about 10% of annual cancer-related deaths. Especially for UICC stage IV, the probability of survival is significantly reduced. Little is known about risk factors for specific metastatic patterns of colorectal cancer that may also influence patients’ overall survival. Methods: We used data from the IQVIA oncology dynamics (OD) database to determine the prevalence of pulmonary metastases in 19,321 patients with UICC stage IV colorectal cancer in eight European and Asian countries. Results: In total, 6132 of 19,321 (31.7%) study patients had lung metastases, with a higher prevalence among patients with rectal (37.5%) than colon (30.1%) cancer. When compared to China as the country with the lowest lung metastases prevalence, the odds for lung metastases were highest in UK (OR: 2.02, 95%CI: 1.80–2.28), followed by Italy (OR: 1.86, 95%CI: 1.52–2.27), Spain (OR: 1.85, 95%CI: 1.64–2.09), and Germany (OR: 1.47, 95%CI: 1.26–1.71). Conclusion: The prevalence of pulmonary metastases in UICC stage IV colorectal cancer varies widely among the different analyzed countries. Although the present data are purely descriptive, a possible combination of ethnic, environmental, and health care system-associated differences could be discussed as the underlying cause. Further studies are needed to investigate the reasons for differences in the prevalence of lung metastases.

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Outcomes after resection of pulmonary metastases in patients with colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.757 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 757-757

Author(s):

Kaihong Mi ◽

Michael J. McNamara ◽

Xuefei Jia ◽

Yazeed Sawalha ◽

Katherine Glass ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Liver Metastases ◽

Lung Metastasis ◽

Pulmonary Metastases ◽

Lung Metastases ◽

Cleveland Clinic ◽

Outcome Data ◽

Colorectal Lung Metastases ◽

Study Population

757 Background: Surgical resection of liver metastases provides a significant survival benefit, and potential for cure, in selected patients with metastatic colorectal cancer. There are very limited data on resection of lung metastases in patients with colorectal lung metastases. We evaluated outcomes after resection of lung metastases in patients with colorectal cancer. Methods: We conducted a retrospective cohort study in patients who underwent resection of pulmonary metastases between 2/2006 and 6/2013 at Cleveland Clinic. Clinical, pathologic, and outcome data were collected by electronic medical records review. Overall survival (OS) as the primary endpoint was summarized by Kaplan-Meier method and analyzed by log-rank tests. Results: The study population comprised 32 patients. Overall, 20 patients were male and median age at diagnosis of lung metastasis was 60.0 years (range 30.4-81.9). All patients had resection of primary tumor. Eleven patients had preoperative chemotherapy and 12 had adjuvant chemotherapy. Patients with unilateral metastases comprised the majority of patients (N = 22, 68.8%); 59% (N = 19) had a solitary metastasis. The median diameter of lung metastases was 20.5 mm (range 7.0 -50.0). Ten patients had concurrent liver metastases, eight of whom had liver resection as well. Overall, 31% (10/32) of patients recurred, with 50% (16/32) of recurrences in the lung, and 28% died. Estimated median OS was 55.0 months. Estimated 5-year OS was 32% ± 17%. Higher CEA level ( ≥ 4.5 ng/mL) at the time of diagnosis of lung metastasis was associated with worsened OS (p = 0.026). Other potential prognostic factors, such as laterality, number of lung metastases, and extrapulmonary lesions, were not associated with overall survival in this study population. Conclusions: Our study showed resection of lung metastases in select patients with colorectal cancer can be associated with prolonged survival in the range seen with resection of liver metastases. Higher CEA level at time of diagnosis of lung metastasis is associated with poorer prognosis. More data are necessary to identify approaches to patient selection in the metastatic colorectal setting.

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Unexpected Tension Pneumothorax-Hemothorax during Induction of General Anaesthesia

Case Reports in Anesthesiology ◽

10.1155/2019/5017082 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Ekaterini Amaniti ◽

Chrysoula Provitsaki ◽

Panagiota Papakonstantinou ◽

George Tagarakis ◽

Konstantinos Sapalidis ◽

...

Keyword(s):

General Anaesthesia ◽

Systemic Disease ◽

Good Condition ◽

Tension Pneumothorax ◽

Positive Pressure ◽

Aged Woman ◽

Breath Sounds ◽

Middle Aged Woman ◽

Chest X Ray ◽

The Right

Tension pneumothorax during general anaesthesia is a rare but possibly deleterious event, especially where predisposing factors are absent or unknown, making diagnosis even challenging. We describe a case of a healthy middle-aged woman, who was planned to receive general anaesthesia for total thyroidectomy. After intubation, the patient experienced marked hypoxemia (SpO2=75%), hypotension, and tachycardia. Manual positive pressure ventilation seemed to worsen hypoxemia and tachycardia, while apnoeic oxygenation through circle system with valve open slightly improved cardiorespiratory collapse. The effect of positive ventilation, along with the absence of breath sounds in the right hemithorax and cardiorespiratory collapse, established the diagnosis of tension pneumothorax, managed immediately with emergency thoracentesis and placement of a thoracostomy tube. The patient was improved and pneumothorax was confirmed with chest X-ray and CT. The latter also confirmed the presence of bilateral multiple bullae. The operation was postponed and the patient was extubated a few hours later, in good condition. After thorough evaluation for any systemic disease, which was negative, the patient underwent two-stage thoracotomy for bullectomy.

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Coronariaeredési anomáliák kardio-CT-vizsgálatok során

Orvosi Hetilap ◽

10.1556/650.2020.31881 ◽

2020 ◽

Vol 161 (47) ◽

pp. 1995-1999

Author(s):

László Barna ◽

Zsuzsanna Takács-Szabó ◽

László Kostyál

Keyword(s):

Computed Tomography ◽

Chest Pain ◽

Coronary Artery ◽

Right Coronary Artery ◽

Sinus Of Valsalva ◽

Coronary Anomalies ◽

Coronary Computed Tomography ◽

Left Circumflex Artery ◽

The Right ◽

Left Sinus Of Valsalva

Összefoglaló. Bevezetés: Congenitalis coronariaanomáliának tekintik azokat a coronariamorfológiai rendellenességeket, melyek 1%-nál kisebb gyakorisággal fordulnak elő. Többségük nem jár tünettel, olykor azonban okozhatnak mellkasi fájdalmat, eszméletvesztést, és hirtelen halálhoz is vezethetnek. A coronariaanomáliák gyakoriságáról Magyarországon eddig csak invazív koronarográfiás adatok alapján jelent meg közlemény. Célkitűzés: Jelen vizsgálatunkban a coronariák eredési rendellenességeinek gyakoriságát mértük fel intézetünk coronaria-komputertomográfiás angiográfián átesett betegeinél. Módszer: A coronaria-komputertomográfiás vizsgálatra került betegek felvételeinek értékelésekor rögzítettük a coronariaanomália jelenlétét. A vizsgálat indikációja általában mellkasi fájdalom volt. 128 szeletes berendezést használtunk, a vizsgálatok során részben retrospektív, részben prospektív EKG-kapuzást alkalmaztunk. Eredmények: 1751 beteg komputertomográfiás angiográfiás felvételeit elemeztük. A betegek között a férfiak aránya 38,4%, a vizsgálatra kerülők életkorának átlaga pedig 58,07 ± 11,07 év volt. Eredési anomáliát 1,83%-ban találtunk, ezen belül a leggyakoribb volt a körbefutó ág (ramus circumflexus) és az elülső leszálló ág különálló eredése a bal Valsalva-sinusból (1%). A további rendellenességek a következők voltak: a jobb coronaria eredése magasan az aortából (0,34%), ramus circumflexus a jobb sinusból vagy a jobb coronariából (0,34%), jobb coronaria a bal Valsalva-sinusból (0,057%), elülső leszálló ág részben a bal Valsalva-sinusból a circumflexustól külön, részben a jobb coronariából (kettős elülső leszálló ág, 0,057%). Következtetés: Mindössze 0,057%-ban fordult elő potenciálisan tünetet okozó coronariaeredési rendellenesség (a bal sinusból eredő jobb coronaria). A komputertomográfiás angiográfia segítségével a coronariaeredés helye pontosan megállapítható, tisztázható az ér lefutása és ennek során viszonya a környező struktúrákhoz. Orv Hetil. 2020; 161(47): 1995–1999. Summary. Introduction: Congenital coronary artery anomaly is defined as a coronary morphology which occurs in less than 1% of the cases. Usually these anomalies do not result in symptoms but sometimes they can cause chest pain, syncope and sudden death. In Hungary, the prevalence of these abnormalities was published only from data of invasive coronary angiography. Objective: In this study, we evaluated the prevalence of the anomalies of coronary origin in the patients of our institution undergoing coronary computed tomography. Method: While reading the computed tomography angiograms of our patients, we registered the presence of coronary anomalies. In most of the cases, the indication of the coronary computed tomography was chest pain. A scanner with 128 detectors was used, scans were performed partly with prospective, partly with retrospective ECG gating. Results: We assessed 1751 patients. The ratio of males was 38.4%, while the average age of patients 58.07 ± 11.07 years. Anomaly of coronary origin was present in 1.83% of our patients, with the separate origin of left anterior descending and left circumflex artery being the most frequent (1%) among them. Other anomalies were as follows: high take-off of the right coronary artery from the ascending aorta (0.34%), left circumflex arising from the right sinus of Valsalva or from the right coronary (0.34%), right coronary artery from the left sinus of Valsalva (0.057%), left anterior descending arising partly from the left sinus of Valsalva, apart from the left circumflex, partly from the right coronary (dual left anterior descending artery, 0.057%). Conclusion: The prevalence of potentially symptomatic coronary anomalies was only 0.057% in our series (right coronary from the left sinus of Valsalva). The computed tomography angiography can precisely define the origin of the coronary artery, depict its run-off and its relationship to the neighbouring structures. Orv Hetil. 2020; 161(47): 1995–1999.

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