The anomalous origin of the right coronary artery is a rare condition, but it has clinical importance because there have been reports of nonfatal or fatal myocardial infarction and sudden death associated with exercise for patients with this anatomy. We describe here a patient for whom 64 channel multi-detector row computed tomography was useful to identify this anomaly, and intravascular ultrasound was used to evaluate the myocardial ischemia by visualizing the coronary lumen.