Efficacy of multidetector computed tomography for diagnosis of unroofed coronary sinus

Area of Science:

• Cardiology
• Medical Imaging
• Congenital Heart Disease

Background:

• Unroofed coronary sinus (CS) is a rare congenital cardiac anomaly.
• Transthoracic echocardiography (TTE) has limitations in visualizing posterior cardiac structures, often hindering diagnosis.
• Chest X-ray may reveal abnormalities but lacks specificity for CS anomalies.

Purpose of the Study:

• To highlight the diagnostic challenges of unroofed CS using conventional methods.
• To demonstrate the utility of multidetector computed tomography (MDCT) in diagnosing unroofed CS.
• To emphasize MDCT's role in providing detailed structural information for rare cardiac anomalies.

Main Methods:

• A case study of a 62-year-old woman with a chest X-ray abnormality.
• Initial evaluation with transthoracic echocardiography (TTE) showing dilated cardiac chambers and an enlarged coronary sinus (CS).
• Advanced imaging using contrast-enhanced 64-slice multidetector computed tomography (MDCT) with curved planar reconstruction.

Main Results:

• TTE revealed right ventricular and atrial dilation and an enlarged CS, but was inconclusive for diagnosis.
• MDCT demonstrated a direct connection between the left atrium and CS, alongside the CS to right atrium connection.
• MDCT provided clear visualization of the CS morphology, confirming the diagnosis of unroofed CS.

Conclusions:

• Unroofed CS is a rare congenital anomaly that poses diagnostic difficulties with TTE alone.
• MDCT is a valuable tool for accurately diagnosing unroofed CS by providing detailed anatomical information.
• Advanced imaging techniques like MDCT are crucial for characterizing complex congenital cardiac defects when TTE is insufficient.