PMC5355631_01
Transthoracic echocardiography on presentation showed: A. the appearance of the giant aneurysm of the coronary sinus in the parasternal long-axis view; B. tissue Doppler imaging velocities at the septal mitral annulus: early diastolic myocardial velocity (e') was 5.85 cm/s and systolic myocardial velocity (s') was 10.4 cm/s. RV, right ventricle; LA, left atrium; LV, left ventricle; CSA, coronary sinus aneurysm; AO, ascending artoa, a', late diastolic myocardial velocity.
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F1
Transthoracic echocardiography showed an enlarged right atrium and a huge cavity behind the left heart (Fig. 1A). Tissue Doppler imaging (TDI) velocities at the septal mitral annulus showed that early diastolic myocardial velocity (e') and systolic myocardial velocity (s') were 5.85 and 10.4 cm/s, respectively (Fig. 1B).
A. Transoesophageal echocardiography colour Doppler flow imaging demonstrated flow from the coronary sinus aneurysm to the right atrium. B. Cardiac catheterisation showed the appearance of the giant coronary sinus aneurysm. RA, right atrium; IVC, inferior vena cava; CSA, coronary sinus aneurysm.
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F2
Colour Doppler flow imaging demonstrated a to-and-fro flow between the cavity and right atrium (Fig. 2A). Cardiac catheterisation showed the shape of the CS aneurysm (Fig. 2B).
Contrast-enhanced CT showed a giant aneurysm of the coronary sinus (*) and a giant aneurysm of the superior vena cava (**).
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F3
Contrastenhanced computed tomography (CT) showed a giant cavity (10.4 x 7.3 cm) connected with three cardiac veins (Fig. 3A) and revealed that it was an aneurysm of the CS. CT showed no evidence of pericardial calcification or thickening. CT also revealed a dilated inferior vena cava (IVC), aneurysmal dilated SVC (7.4-cm diameter, Fig. 3B), and a thrombus in the SVC and left inferior pulmonary artery.
Transthoracic echocardiography performed four years prior to presentation showed: A. the aneurysmal dilated CS was 5 cm in diameter; B. tissue Doppler imaging velocities at the septal mitral annulus: early diastolic myocardial velocity (e') was 6.54 cm/s and systolic myocardial velocity (s') was 19.5 cm/s. RV, right ventricle; RA, right atrium; CSA, coronary sinus aneurysm; a', late diastolic myocardial velocity.
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F4
SVC was 3 cm in diameter. Septal mitral annulus e' and s' velocity were 6.54 and 19.5 cm/s, respectively (Fig. 4A).