Anatomical variations in coronary and bronchial arteries can significantly impact clinical management and interventional procedures. A rare case of the separate origin of the left circumflex artery (LCX) from the left coronary sinus was reported, coexisting with a tortuous and hypertrophied right bronchial artery, identified on contrast-enhanced computed tomography (CT) angiography. The absence of the left main coronary artery, observed in this patient, occurs in approximately 0.4% of the population and is relevant for percutaneous coronary interventions, stent placement, and surgical grafting. Coronary artery tortuosity may further complicate catheterization and contribute to myocardial ischemia. The tortuous, hypertrophied bronchial artery increases the risk of haemoptysis and may complicate embolization. Although each anomaly is uncommon, their concurrent presence is exceptionally rare. This case highlights the importance of thorough pre-procedural imaging and careful anatomical evaluation to guide interventions, minimize procedural risks, and enhance patient management, while contributing to the understanding of rare vascular variations.
