IntroductionCoronary artery anomalies are found in 0.6% to 1.55% of patients who undergo coronary angiography, and the increasing use of diagnostic coronary angiography is uncovering even more such abnormalities. We present a very unusual case of an anomalous origin of the left circumflex coronary artery (LCx) from the proximal right coronary artery (RCA). Case presentationWe present a case of a 45-year-old-man with a recent history of a non ST elevation myocardial infarction. The coronary angiography reveals an ectopic left circumflex coronary artery from the right coronary artery. In this report we attempted to highlight the rarity of this coronary anatomy.Conclusions:Anomalous origins of the coronary artery are rare, but may cause myocardial ischemia and sudden death. Thus, their reliable identification is a matter of paramount importance possibly evaluating the effects of therapeutic intervention.