Giant Chiari's Network in Healthy Adults

A 40-year-old male visited our clinic for cardiac evaluation. He had palpitations for several years, but the reason was unknown. Transthoracic echocardiography revealed a hyperechoic ribbon-shaped structure that moved vigorously in the right atrium. A contrast CT scan was not able to detect any abnormal structure in the right atrium. Giant Chiari's network was suspected. Potential risks or implications of Chiari's network are thrombus formation, embolism, and arrhythmia. If atrial fibrillation (AF) is documented, anticoagulation therapy should be initiated. If an intracardiac thrombus is detected, anticoagulation therapy and/or surgical removal should be considered. Given the absence of atrial fibrillation or thrombus, the necessity of any intervention or anticoagulation remained controversial. Since the Holter monitor did not detect atrial fibrillation, the patient is currently under vigilant observation without medication. The optimal management of asymptomatic Chiari's network should be established.