We applied echocardiographic imaging modalities in a 69-year old man to demonstrate circumflex coronary artery (CA) abnormal course and coronary stenosis-related flow abnormalities of the left coronary artery. Angiography revealed 90% left CA ostial stenosis; circumflex CA originating next to the right CA, distally narrowed to 90%. Transthoracic echocardiography (TTE) confirmed critical stenosis in the left CA ostium, turbulent flow, reduced coronary flow reserve. Using color Doppler we identified the abnormal orifice of the circumflex CA from the right sinus of Valsalva. TTE is a valid tool for coronary anatomy evaluation and high-quality visualization of stenosis allows non-invasive semi-quantification.