Coronary anatomy matters: Dual LAD presenting as atypical ischemia on myocardial perfusion imaging

Myocardial perfusion imaging is susceptible to imaging artifacts that may limit its clinical utility. One approach to differentiate true perfusion defects from artifacts involves examining the presence of perfusion abnormalities that align with the typical anatomy of coronary vessels. However, this approach may not be applicable in patients having coronary anomalies. We report a patient with dual LAD exhibiting isolated ischemia of the anteroseptal wall on MPI, resembling artifact typically observed in patients with LBBB. The present case highlights the importance of familiarity with variations in coronary anatomy, like dual LAD, to avoid misinterpretation of atypical perfusion defects observed in MPI.