Right-sided aortic arch with anomalous coronary artery origin and concomitant Stanford type A dissection: A rare case report.

Congenital anomalies of the aortic arch are rare and may be incidentally discovered or present with life-threatening complications. We report a case of a 58-year-old man with hypertension and a remote history of smoking, who presented with sudden, severe chest pain radiating to the back, hypotension, tachycardia, and pallor. Bedside ultrasound revealed moderate pericardial effusion and raised suspicion of aortic dissection. ECG-gated CT angiography (CTA) confirmed a Stanford type A aortic dissection with a right-sided aortic arch (RAA) and anomalous origin of the right coronary artery from the left main coronary artery. Despite supportive management and preparation for emergent surgery, the patient developed progressive shock and died. This case highlights the importance of rapid recognition of rare aortic arch anomalies and concomitant coronary anomalies using advanced imaging, which is critical for surgical planning in acute settings.