Coronary sinus thrombus without spontaneous contrast

Excerpt

A 76-year-old man with chest pain and transient aggravation of chronic dyspnea was admitted through the emergency room. He had a medical history of chronic cor pulmonale due to pulmonary fibrosis. His ECG showed atrial fibrillation with fast ventricular rate, extreme right axis deviation and a rS pattern in all precordial leads (Fig. 1a); in a previous ECG the patient has had left bundle branch block. He was under chronic oral anticoagulation with acenocumarol, outside therapeutically range. Due to the high suspicion of pulmonary thromboembolism, a CT-scan chest was performed. No thrombus in the pulmonary artery circulation was detected. However, the cross section of the coronary venous sinus (CS) showed its dilatation and an irregular mass (arrow) of about 8.3 mm inside the CS, most likely a thrombus (Fig. 1b, Supplementary movie 1). Transthoracic echocardiography revealed dilated right ventricular cavities and a pulmonary artery systolic pressure of 75–80 mmHg. Parasternal long axis views confirmed a visible thrombus (arrow) in a dilated CS (Fig. 1c, Supplementary movie 2), without spontaneous contrast in cardiac cavities.

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