The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome is a rare congenital coronary artery anomaly. The development of acquired collateral circulation between the right coronary artery and the left coronary artery allows, sometimes, survival until adulthood. In our clinical practice, we came across an exceptional case for the advanced age, 75 years. Coronary computed tomography, associated with other imaging modalities, has played a crucial role in accurately defining the origin, the course and the connection of the coronary arteries.