Bland-White-Garland syndrome, also known as anomalous origin of the left coronary artery from the pulmonary artery, is a rare congenital disorder affecting around one in 300,000 live births. The majority of these present within the first year of life with 90% mortality rate if untreated and consequently is an extremely rare presentation in the adult. We present the first published case with a left dominant system in an adult presenting in their late 20s, illustrated by multimodality imaging.