Chest and cardiac imaging: anomalous left coronary artery: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Chest and cardiac imaging: anomalous left coronary artery

Sample item

A 3-month-old infant sweats and is irritable during feeds. Echocardiography shows a dilated, hypokinetic left ventricle, and the ECG shows an anterolateral infarct pattern. Doppler shows retrograde flow in the left coronary artery. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Anomalous origin of the left coronary artery from the pulmonary artery

In ALCAPA the left coronary artery arises from the pulmonary trunk, and as pulmonary pressure falls the myocardium is perfused by retrograde flow and becomes ischaemic. It presents in infancy with heart failure and an infarct pattern. Kawasaki disease occurs later with aneurysms, and myocarditis does not reverse coronary flow.

Option by option

  • A. Kawasaki disease with coronary aneurysm

    Kawasaki disease causes coronary aneurysms in febrile children, not retrograde flow.

  • B. Anomalous origin of the left coronary artery from the pulmonary artery (correct)

    Correct. Retrograde left coronary flow with infarct pattern in an infant is ALCAPA.

  • C. Viral myocarditis

    Myocarditis causes dysfunction without abnormal coronary origin or reversed flow.

  • D. Aortic coarctation

    Coarctation causes upper limb hypertension and rib notching and does not cause infarct patterns in infancy.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Radiology questions

Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is B, Anomalous origin of the left coronary artery from the pulmonary artery. In ALCAPA the left coronary artery arises from the pulmonary trunk, and as pulmonary pressure falls the myocardium is perfused by retrograde flow and becomes ischaemic.

Why is "Kawasaki disease with coronary aneurysm" not the answer?

Kawasaki disease causes coronary aneurysms in febrile children, not retrograde flow.

Why is "Viral myocarditis" not the answer?

Myocarditis causes dysfunction without abnormal coronary origin or reversed flow.

Why is "Aortic coarctation" not the answer?

Coarctation causes upper limb hypertension and rib notching and does not cause infarct patterns in infancy.

What concept does this question test?

It tests Chest and cardiac imaging: anomalous left coronary artery in Radiology. It presents in infancy with heart failure and an infarct pattern. Kawasaki disease occurs later with aneurysms, and myocarditis does not reverse coronary flow.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Chest and cardiac imaging: anomalous left coronary artery?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.