Abstract
We report a case of a 49-year-old female who presented with atypical chest pain. An electrocardiogram-gated coronary computed tomography angiography revealed the absence of the left main coronary artery segment with direct origin of the left anterior descending artery and the left circumflex artery from the left coronary sinus having separate ostia. The case highlights a rare anomaly of coronary artery origin with procedural implications.