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A chiari network mimicking a cystic structure
J. Walpot
G. Sahin-Arpaci
M. Sadreddini
The Chiari network is a net-like mobile structure, occasionally encountered near the entrance of the inferior vena cava in the right atrium. Due to its fenestration, the Chiari network does not cause flow obstruction of the blood. The Chiari network is usually an incidental finding with no further clinical consequences. We report an unusual presentation of a Chiari network, mimicking a right atrial oscillating cystic mass attached to the interatrial septum by a thin stalk. Electronic supplementary material The online version of this article (doi:10.1007/s12471-014-0621-1) contains supplementary material, which is available to authorized users.
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A 66-year-old man suffered from a cerebrovascular
insult. The ECG showed sinus rhythm. Holter tape
recording did not demonstrate paroxysmal atrial
fibrillation. The transthoracic echocardiographic (TTE) study
showed a preserved left and right ventricular systolic
function. An oscillating cystic structure, attached to the
interatrial septum (IAS) by a thin stalk, was seen in the
right atrium. (Fig. 1, Video 1)
Further analysis by TEE revealed an elongated
Eustachian valve and a large mobile Chiari network.
(Fig. 2, Video 2 and 3) The Chiari network was
identified as the structure causing the pseudocystic image,
which had been seen on TTE. Intravenous injections of
agitated colloid solution could not demonstrate a
punched out lesion consistent with a cyst. Furthermore,
a patent foramen ovale was excluded.
The Chiari network, a remnant of the right valve of
the sinus venosus, is a mobile net-like structure
occasionally seen in the right atrium near the opening of
the inferior vena cava and coronary sinus. Due to its
fenestration, the Chiari network does not cause flow
obstruction of the blood. It is usually an incidental
finding with a reported prevalence ranging from 2 to
13.6 % in echocardiography studies and autopsy series
[13]
Prevention of pulmonary embolism due to entrapment of
thrombi, originating from the deep venous system, in the
Fig. 1 The TTE four-chamber view demonstrates a cystic mass
attached to the interatrial septum by a thin stalk in the right atrium.
(See also Video 1)
Fig. 2 TEE image at 69 shows
the large Chiari network in the
right atrium. (See also Video 2)
Chiari network has occasionally been reported [4] A few
medical case reports have described entrapment of catheters
in the Chiari network during invasive procedures [5] Rarely,
the Chiari network is identified as the site of infective
endocarditis.
Conflicts of interest None.
Open Access This article is distributed under the terms of the Creative
Commons Attribution License which permits any use, distribution, and
reproduction in any medium, provided the original author(s) and the
source are credited.
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