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Dilated coronary sinus measurement

Image 2 of 4 in Series "Evaluation of a Persistent Left Superior Vena Cava"

Description

In this image, it is important to be able to distinguish between a dilated coronary sinus and the descending aorta. The coronary sinus is the structure inside of the pericardium while the descending aorta sits outside of the pericardium. Here the coronary sinus measures 2.96cm. Normal size is between 0.5cm and 0.9cm.

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This image is part of the series "Evaluation of a Persistent Left Superior Vena Cava"

Other images in this series

Dilated coronary sinus on parasternal long axis view

by: Raymond Mai, DO

In this parasternal long view axis view, a dilated coronary sinus was incidentally detected.

Dilated Right Atrium

by: Raymond Mai, DO

Unlike the right ventricle which should be measured in a dedicated right ventricular view, the right atrium should be measured in a standard apical 4 chamber view in order to avoid foreshortening. In this image, both the right ventricle and the right atrium are severely dilated giving off the appearance of a right ventricle focused apical 4 chamber view. A dilated right atrium and a dilated coronary sinus should raise suspicion of a persistent SVC.

Persistent Left Superior Vena Cava: Bubble Study

by: Raymond Mai, DO

In order to confirm a persistent left superior vena cava (SVC), a bubble study should be performed via the left arm. Visualizing the timing of bubbles in each cardiac structure can be challenging but with M-mode, which has excellent temporal resolution, we see bubbles clearly showing up in the coronary sinus first and then the right-sided chambers. Note that the bubbles flow from the left SVC into the coronary sinus, into the right atrium and finally the right ventricle.