1. To illustrate the venous anatomy of heart. The coronary system generally receives little attention in the medical literature.Cardiologists mostly consantre on cardiac arteries but venous system of heart must not tobeneglected. 2. In this poster, our purpose is to present a case of coronary sinus thrombosis (CST) with CT findings and to take attention on coronary system.

Anatomy of cardiac venous system The venous drainage of the heart consists of two separate systems draining the right and left ventricular arterial flow. Normally the right ventricle is drained via the anterior cardiac veins running along the anterior right ventricular surface and draining separately into the right atrium; this accounts for approximately 15% of the total cardiac venous return. The remainder of the cardiac venous return is via the coronary sinus, a large venous channel running in the left atrio-ventricular sulcus. Fig. 1 Tributaries...

A 79 years old male patient was evaluated for chest pain and breathlessness at the emergency room. He has been chronic renal failure since 1996 and he had no history of invasive cardiac procedures.Cardiac markers and D-dimer test, electrocardiography, echocardiography and chest MDCT were performed. MDCTA scanning protocol: Aquilion 64 MDCT, Toshiba Slice thickness:2 mm kVp: 120, mAs: 100 18G IV cannula placed in a distal arm vein Bolus track (OptiVantageTM);180 H.U.threshold, then 12-16 sec scan delay. 100ml @ 4.5 ml/s di iodinated contrast medium...

CST is a rare acquired anomaly of the coronary sinus. It has been reported only as a complication of cardiac transplantation and right heart catheterization in non infected patients. In cardiac procedures that use access to the right atrium, such as insertion of central venous lines, pacing wire, coronary sinus catheterisation for ventricular lead placement during cardiac resynchronisation therapy, the CS is at risk of accidental trauma and subsequent thrombosis. Our case had an acute coronary sinus thrombosis occurring in the absence of these procedures.

Vinayak NB, Ashutosh AH, Manish MP, Nandkishor BA, et al. Coronary sinus thrombosis after cannulation during cardiopulmonary bypass. Ann Thorac Surg. 1996;62:1506-7. James, TN: Anatomy of the coronary arteries and veins. In Hurst, JW, et a1 (eds): “The Heart.” New York: McGraw-Hill, 1978, p 26. Ramsaran EK, Sadigh M, Miller D. Sudden cardiac death due to primary coronary sinus thrombosis. South Med J. 1996;86:531-533. O’Cochlain B, Delurgio D, Leon A. Biventricular pacing using two pacemakers and the triggered VVT mode. Pacing Clin Electrophysiol. 2001; 24(8...