Coronary Artery Anomalies: Benign Entities or Pathologic Findings?

Abstract

Many cases of sudden, natural death have obvious gross or histologic pathology to which the death can be attributed fairly easily. Sometimes, though, one encounters a death in which an abnormal finding is identified, but there is some hesitancy in attributing the death to it as one may be unfamiliar with the significance of the finding or has encountered it many times before in cases where death was clearly due to something else. Coronary artery anomalies firmly fit into this category for many pathologists. Anomalous origin of the coronary arteries is an uncommon anomaly occurring in a fraction of a percent of individuals, so one may only encounter one or two deaths with this lesion in his/her career. Without past experiences to rely upon, one may be unsure about the severity of the lesion and inadvertently dismiss a significant anomaly or attribute death to a benign variant. Myocardial bridging is on the other end of the spectrum. This entity is seen so commonly that many consider it to be a normal variant and entirely benign and incidental. While this may be true in the majority of individuals, myocardial bridging may cause cardiac dysfunction in a small subset of people. This manuscript will review the anatomy and potential pathophysiology of these anomalies with the goal of aiding the pathologist in certifying deaths in which they are encountered.