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An 84-year-old male was admitted to the emergency department with a complaint of angina pectoris. His vital signs were normal, including the blood pressure (130/65 mmHg) and the heart rate (59 bpm). Although his troponin-I levels were within normal limits, coronary angiography was performed to exclude possible underestimation of a coronary artery disease. Although no prominent lesion in the coronary vasculature was detected, a rare anatomic variation was observed. The left coronary arteries were originating from the aorta with a separate ostium having no common left main trunk (Figure 1a, b). The course of the left coronary arteries was normal. However, there was a muscular bridge on the mid-portion of left anterior descending artery (Figure 1c, d). The origin and course of the right coronary artery were normal.

A muscular bridge with an absent left main trunk: A rare coronary artery anomaly