Congenital coronary artery anomalies are a well-recognized risk factor for sudden cardiac death in children as well as young adults, mostly during or immediately after intense exertion on the athletic field. Because these malformations are amenable to surgical treatment, timely identification is crucial. Unfortunately, antemortem diagnosis is notoriously difficult, partly due to the absence of abnormal test results in routine investigations. We present a 15-year-old boy who collapsed during exercise due to ventricular fibrillation. Coronary abnormalities were initially not identified, but they were clearly visualized by means of an echocardiogram and confirmed by multislice computed tomography. We would like to emphasize that echocardiography is capable of accurately identifying congenital coronary anomalies when attention is paid to the correct diagnostic hallmarks.
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