Background: Anomalous origin of right coronary artery (AORCA) which courses between the aorta and pulmonary trunk is very rare and known to be related with sudden cardiac death. The purpose of this study was to evaluate the clinical and angiographic characteristics of AORCA detected in a single center. Methods: 6051 coronary angiography (CAG) and 144 coronary multi-detector computed tomography (MDCT) which performed between May 2004 and June 2007 were reviewed. Results: A total of 14 patients (10 men; mean age, 47.6 짹 13.7 years, range 19 - 65 years) were found to have AORCA and all of them had inter-arterial passage. 13 patients were detected by CAG initially and performed coronary MDCT to confirm the course of RCA. One patient was detected directly by coronary MDCT. 5 patients had typical chest pain and 4 of them performed revascularization due to significant left coronary artery stenosis. Except those 4 patients, remaining patients showed non-specific findings in electrocardiography, cardiac enzyme and echocardiography. RCA originated from ascending aorta in one patient, from left main trunk in one patient, and from the left sinus of Valsalva in remaining 12 patients in which 4 patients shared orifice with left coronary artery. Significant combined right coronary stenosis was not found in all 14 patients. In 12 patients, proximal RCA in inter-arterial course looked like to be compressed in coronary MDCT. Quantitative coronary angiographic analysis showed that 9 proximal RCA were measured smaller than distal potion about 22% in mean luminal diameter. Conclusion: Patients with AORCA presented atypical chest pain and their clinical characteristics were non-specific. Coronary MDCT provided accurate information for coronary anatomy including their course even without CAG. Therefore, in the evaluation of atypical chest pain especially in young population, coronary MDCT need to be considered as a screening tool.