Coronary artery anomalies that entail a risk of sudden death are frequently associated with complex cardiac malformations but may occasionally be solitary. A 31-year-old man became ill in the night and lost consciousness. He was taken to a hospital where he was treated. However, he died on the same day. The death was considered to be suspicious and an autopsy was mandated. On macroscopic examination, the heart weighed 410 g. A single coronary artery that originated from the right aortic sinus was found. The coronary artery ostium was 0.8 cm in diameter and had a hole-like shape. Demonstration of coronary artery pathologies in autopsies is vital for the elucidation of sudden death cases related to these lesions and for the development of new treatment approaches. The aims of this case report are to contribute to a better understanding of the coronary artery anomalies and emphasise their medicolegal importance.