Dilated coronary sinus and Persistent Left SVC
Dilated Coronary Sinus
The agitated saline test confirms a persistent left superior vena cava (PLSVC) when contrast bubbles flow directly into the coronary sinus (CS) before entering the right side of the heart.
The differential diagnoses considering dilated CS and RCA were as follows.
Dilated coronary sinus
1. Conditions for elevated right atrial pressure and systolic pulmonary arterial pressure
2. Abnormal venous drainage in the coronary sinus
2.1 ) Persistent left superior vena cava
2.2 ) Total anomalous pulmonary venous connection
2.3 ) Unroofed coronary sinus
2.4 ) Coronary artery fistula
Dilated coronary artery or coronary artery aneurysm
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Atherosclerosis
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Coronary artery fistula
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Kawasaki disease
Persistent left superior vena cava anatomic variations
Normal anatomy
Persistent Left SVC and its tributaries draining into the coronary sinus
Persistent Left SVC and its tributaries draining into left atrium by means of an unroofed coronary sinus
Persistent left SVC draining into coronary sinus and also connected to the right SVC
Persistent left SVC with an absent right SVC
References
1) Son BJ, Kim H, Nam JH. Differential diagnosis for unusually dilated coronary sinus and right coronary artery incidentally found on echocardiography. J Yeungnam Med Sci. 2023 Oct;40(4):461-465. doi: 10.12701/jyms.2023.00906. Epub 2023 Oct 6. PMID: 37797950; PMCID: PMC10626301.
2) Rizkallah, J., Burgess, J. & Kuriachan, V. Absent right and persistent left superior vena cava: troubleshooting during a challenging pacemaker implant: a case report. BMC Res Notes 7, 462 (2014). https://doi.org/10.1186/1756-0500-7-462