Absent proximal RCA with a supra-dominant circumflex (CX) supplying the distal and mid-RCA. Incidental OM2 aneurysm.

This is a 70-years old man with mild disease who has an unusual anatomy. The proximal RCA is absent and does not arise from the aorta. The circumflex (CX) is supra-dominant and the PL continues as the RCA upto the mid-portion (Figs. 1-4). The MIP (Fig. 5) also shows this well. Note the aneurysm arising from the OM2. There is considerable ectasia of almost all the vessels.