Image Question-59
What is the structure marked ?
A. Cor triatriatum
B. Parachute mitral valve
C. Mitral valve prolapse
D. Dilated coronary sinus
Aneurysmal dilated coronary sinus – structure (yellow arrow)
A dilated coronary sinus (CS) on echocardiography or imaging is an important clue to underlying pathology.
Causes of a Dilated Coronary Sinus
- Persistent left superior vena cava (PLSVC) – most common cause.
- Elevated right atrial pressure – secondary to:
- Right heart failure
- Pulmonary hypertension
- Severe tricuspid regurgitation
- Constrictive pericarditis
- Coronary arteriovenous fistula draining into the coronary sinus.
- Unroofed coronary sinus (rare congenital anomaly, may be associated with atrial septal defect).
- Iatrogenic causes – e.g., pacemaker or ICD leads placed via CS.
👉 In exams, dilated coronary sinus is a red flag for persistent LSVC until proven otherwise.
Q1. The most common cause of a dilated coronary sinus is:
Q2. Which echocardiographic view best shows a dilated coronary sinus?
Q3. A dilated coronary sinus with bubble contrast appearing after left arm injection indicates:
Q4. Which congenital anomaly is most commonly associated with a dilated coronary sinus?
Q5. Elevated right atrial pressure may cause CS dilation in all EXCEPT:
Q6. Which rare congenital defect directly involves the coronary sinus wall?
Q7. Which invasive procedure most often uses the coronary sinus?
Q8. CS dilation in the absence of LSVC or RA hypertension should raise suspicion of:
Q9. Which valve abnormality is LEAST likely to cause CS dilation?
Q10. Which imaging modality best delineates an unroofed coronary sinus?
Q11. During echo, a circular echo-free structure posterior to LA suggests:
Q12. Which test helps differentiate persistent LSVC from other causes of CS dilatation?
Q13. Which syndrome is associated with unroofed coronary sinus?
Q14. Dilated CS is most likely to be mistaken for which echo structure?
Q15. In CRT device placement, the lead in coronary sinus is used to pace:
Q16. Which is NOT a consequence of dilated coronary sinus?
Q17. Which pressure abnormality most directly causes CS dilation?
Q18. In persistent LSVC, coronary sinus drains blood into:
Q19. Which anomaly may result in systemic desaturation with a dilated CS?
Q20. Which intervention may be complicated by an unrecognized dilated CS?
Here are the keywords for Dilated Coronary Sinus (separated by commas as you prefer):
Dilated coronary sinus, Persistent left superior vena cava, PLSVC, Right atrial pressure, Right heart failure, Pulmonary hypertension, Severe tricuspid regurgitation, Constrictive pericarditis, Coronary arteriovenous fistula, Unroofed coronary sinus, Congenital heart disease, Pacemaker lead, ICD lead, Cardiac venous anatomy, Echocardiography coronary sinus, Bubble contrast echocardiography, Coronary sinus dilation causes, Coronary sinus anomalies, Left arm contrast injection, Dilated coronary sinus differential diagnosis
