Anomalies in the origin of coronary arteries (AOCA) though rare can lead to serious clinical outcomes such as myocardial ischemia or even sudden death. MDCT has transformed noninvasive evaluation of the coronary arteries by providing high-resolution imaging capabilities. Here is a case series of overview of the imaging features, classification, and clinical implications of anomalous coronary origins as seen on 128-slice MDCT, emphasizing its critical role in diagnosis, evaluating risk, and guiding surgical management. In our institute, a total of 250 MDCT coronary angiograms have been done over a period of 2 years, after taking informed consents from the patients. Among them 5 cases had anomalies in the origin of coronary arteries (AOCA)—two cases of anomalous origin of RCA from left coronary sinus with malignant inter-arterial course, one with anomalous origin of Left main coronary artery from noncoronary cusp with retro-aortic course, one with anomalous origin of Left circumflex artery from the right coronary sinus with malignant inter-arterial course and one case of separate origins of Left anterior descending artery and Left circumflex artery from left coronary sinus. Identification of benign and malignant courses is also of utmost importance, because the later may warrant surgical intervention. In our case series the incidence rate of anomalous origins is 2%, closely aligning with those of existing studies in the literature.