dilated coronary sinus on US can be result of persistent left superior vena cava

  • related: Cardiology
  • tags: #literature #pulmonology

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The structure indicated by the arrow is a dilated coronary sinus (choice C is correct). In the parasternal long-axis view, the coronary sinus can be seen at the anterior junction of the left ventricle and left atrium. It sits next to the descending aorta, so care should be taken to differentiate between the two structures. The coronary sinus lies anterior to the pericardium, and the aorta lies posterior to the pericardium. The coronary sinus is not usually seen in the parasternal long-axis view unless it is dilated. When seen, the differential diagnosis includes a persistent left superior vena cava (PLSVC) with drainage into the coronary sinus and the right atrium. This diagnosis is confirmed with a bubble study. In cases of PLSVC, contrast material injected into an antecubital IV access will opacify the coronary sinus before opacification of the right atrium. Other possible causes of a dilated coronary sinus are total anomalous intracardiac pulmonary venous drainage, severe tricuspid regurgitation, increased right atrial pressures due to decreased right ventricular function, coronary sinus diverticulum, or a coronary artery-to-coronary sinus fistula. In this patient, her echocardiogram revealed a dilated right ventricle and high right atrial pressures that required a full workup.

The descending aorta lies posterior to the pericardium, as shown by the arrow in Figure 2 (choice A is incorrect). The structure indicated in the question is not a pericardial effusion because it is very round and appears to be a vessel (see Figure 3 for an example of a pericardial effusion) (choice B is incorrect). The structure in question is not the left atrium because the left atrium is clearly seen above the coronary sinus (Figure 4) (choice D is incorrect).1

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