Abstract
Chiari network, a remnant of sinus venosus is often incidentally diagnosed on routine echocardiograms. Chiari network occurs due to incomplete resorption of right valve of sinus venosus. It is often noticed as fenestrated membranous structure or reticular network like structure in the valve of inferior vena cava and coronary sinus. The structure was first described by Von Rokitansky in 1875 and gained its name after pathologist Hans Chiari in 1897 when he described the structure in 11 cadavers. There are inconsistencies in the exact prevalence of this structure and has been reported in literature from 2-13.6%. Most of this data is available from cadaveric or autopsied hearts. These structures are usually considered as benign congenital malformations but literature has reported various cases which have resulted in medical complications including endocarditis, thromboembolism or procedural difficulties. These structures can also mimic right atrial pathologies or thrombus creating a diagnostic challenge. It is important that clinicians are aware of these since misdiagnosis can have significant effect on clinical course and outcomes of the patients. The possibility of the presence of these congenital remnants should be kept in mind during clinical decision making. We present two clinical scenarios with incidental diagnosis of Chiari network and its effect on the clinical course of these patients.
Highlights
A remnant of sinus venosus, is considered clinically insignificant it is often misdiagnosed as right atrial pathologies or thrombus
There have been various case reports in literature discussing its association with paradoxical embolism, infective endocarditis and arrythmias where as others are talking about its possible protective effect to prevent pulmonary embolism due to its fenestrated sieve-like structure at cavo-atrial junction
Case2: A 54-year-old female with prior history of chronic anticoagulation (AC) with warfarin for presumed right atrial (RA) thrombus on TTE and prior history of gastrointestinal bleed (GIB) complicated by hemorrhagic shock was admitted with non-ST segment elevation myocardial infarction (NSTEMI)
Summary
A remnant of sinus venosus, is considered clinically insignificant it is often misdiagnosed as right atrial pathologies or thrombus. There have been various case reports in literature discussing its association with paradoxical embolism, infective endocarditis and arrythmias where as others are talking about its possible protective effect to prevent pulmonary embolism due to its fenestrated sieve-like structure at cavo-atrial junction. Sometimes it can possess diagnostic confusion since it mimics other right atrial pathologies. This can have serious impacts on clinical outcomes of the patients. We discuss two clinical scenarios with incidental findings of Chiari network and its implication
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