A 60-year-old asymptomatic woman was admitted to hospital for an invasive evaluation of a patent foramen ovale and a suspected formation within the right atrium. Transthoracic and transesophageal echocardiography excluded both, but instead unveiled a huge "brass knuckle"-like ectasia of the right coronary artery meandering down the lateral wall of the right atrium. Coronary anomalies are common and mostly discovered incidentally. Thus, diagnostic and therapeutic approaches should be guided by the clinical scenario of the patient.
Keywords: cardiac imaging; ectasia.