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Congenital coronary artery anomalies are rare but well-described causes of chest pain and, in some cases, link to sudden cardiac death. With the spread of advanced imaging techniques, the number of incidental findings is staggering, but little information has been given in order to rule out potential malignant cases in symptomatic adult patients. Here, we describe a case of an anomalous <b>course</b> of the coronary artery <b>with an acute (<45°) take-off angle, as well as an <i>inter-arterial</i> course between a dilated ascending aorta and a dilated pulmonary artery, and</b> how we could manage this patient in our clinical practice.